Three retrospective studies pointed out the interest of prompt referral. In the first study, the patients transferred to a specialised centre more than 7 days after the onset of epidermal slough had a period of hospitalisation that was more than twice as long as for patients transferred before 7 days, despite other comparable risk factors.16 In another study of 44 patients, delayed transfer was associated with high morbidity and mortality rates.26 Finally, a third retrospective analysis summarised the data of 36 patients with TEN; it showed that patients who survived had been referred earlier than non-survivors (4-0 versus 11-5 days). Patients referred before 7 days had a mortality rate of 4%, compared with 83% for those referred after 7 days. Increased risk of infection in outside facilities was claimed to be the critical factor,27 but in a previously mentioned small retrospective study, there was no difference in the infection or mortality rate in patients who were transferred late.13

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