SCORTEN

SCORTEN is a severity-of-illness scoring system used to predict mortality in patients with toxic epidermal necrolysis (TEN) and, in its original form, Stevens-Johnson syndrome with extensive skin involvement. It was introduced by Bastuji-Garin and colleagues in 2000 and has since become a standard prognostic tool in burn units, dermatology departments, and intensive care settings.

The score is calculated within 24 hours of admission and relies on seven independent risk factors. Each present factor adds one point: age over 40 years; the presence of malignancy; heart rate exceeding 120 beats per minute; initial epidermal detachment greater than 10% of body surface area; serum urea greater than 10 mmol/L; serum glucose greater than 14 mmol/L; and serum bicarbonate less than 20 mmol/L. The total SCORTEN can range from 0 to 7.

Mortality correlates with the total score; higher scores are associated with higher predicted mortality. In the original validation, approximate mortality rates increase with each additional point, ranging from low risk at scores of 0–1 to very high risk at scores of 5 or more, approaching near-inevitably high mortality for the highest scores.

SCORTEN is widely used to stratify risk, guide the intensity of monitoring, and inform discussions about prognosis and resource allocation. It is most accurate when calculated at or shortly after presentation, and while broadly validated across populations, factors such as timing of measurements and comorbid conditions can influence its precision. It is intended as a prognostic aid rather than a directive for specific therapies.