A new clinical score for the prognosis of status epilepticus in adults

González-Cuevas, Montserrat; Santamarina, Estevo; Toledo, Manuel; Quintana, Manuel; Sala, J.; Sueiras, M.; Guzmán, Lorena; Salas-Puig, Javier

doi:10.1111/ene.13073

Cited by 76 publications

(82 citation statements)

References 23 publications

(49 reference statements)

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“…Risk of complications increases as the duration of SE treatment increases, 5,6 and conversely, complications increase the risk of refractoriness 7 and prolong the hospital admittance. 6,[9][10][11] Although complications such as infection, 12 vasopressor use, 9 or mechanical ventilation 13 have been associated singly with poor outcome, only intubation has been included in published outcome scores. 6,[9][10][11] Although complications such as infection, 12 vasopressor use, 9 or mechanical ventilation 13 have been associated singly with poor outcome, only intubation has been included in published outcome scores.…”

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confidence: 99%

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

et al. 2018

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Systemic complications are common in status epilepticus. We have no tools to evaluate total burden of complications and its effect on the outcome of status epilepticus. For Complication Burden Index (CBI) a patient is assessed for 13 complication categories: respiratory, cardiovascular, nervous, renal, hepatic, coagulation, gastrointestinal and musculoskeletal systems, electrolyte/acid-base balance, infection, hypo-/hyperglycemia, skin/allergic reactions, and mental condition. Maximum CBI is 13. CBI was internally validated in a retrospective cohort of 70 consecutive adult patients with generalized convulsive status epilepticus (GCSE) treated in a tertiary hospital over a period of 2 years. Functional outcome at discharge was defined Poor for Glascow Outcome Scale (GOS) 1-3 or worse-than-baseline condition and Good for GOS >3 or return to baseline condition. Relative risks (RRs) and receiver-operating characteristic (ROC) -curves were calculated to obtain optimal cutoff. Functional outcome was poor in 40% and worse-than-baseline in 59%. In-hospital mortality was 7%. Average CBI was 3.8 (range 0-10, median 3). Cutoff value predicting poor functional outcome was a CBI >3 (GOS 1-3 RR 1.84, P = .045, 95% confidence interval [CI 1.01-3.33; ROC-AUC [area under the curve] 0.687, P = .008, sensitivity 64%, specificity 61%; worse-than-baseline condition RR 1.52, P = .04, 95% CI 1.02-2.26; ROC-AUC 0.662, P = .022, sensitivity 56%, specificity 69%). CBI with cutoff >3 and as a continuous variable was associated with GOS1-3 (P = .046, P = .002) and with worse-than-baseline condition (P = .041, P = .004). CBI is a novel tool for comprehensive assessment of status epilepticus complications predicting poor/worse-than-baseline functional outcome with cutoff >3.

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confidence: 99%

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

et al. 2018

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“…9 The source population of mSTESS were consecutive SE patients from a tertiary hospital. 9 The source population of mSTESS were consecutive SE patients from a tertiary hospital.…”

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confidence: 99%

Prognostic scores in status epilepticus—a critical appraisal

2018

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Currently, there are 4 published scales evaluating status epilepticus (SE) prognosis: the Status Epilepticus Severity Score (STESS), the Epidemiology-based Mortality score in Status Epilepticus (EMSE), the modified STESS (mSTESS), and the Encephalitis Nonconvulsive Status Epilepticus Diazepam Resistence Imaging Tracheal Intubation (END-IT) score. The first prognostic score published for SE, the STESS, is a simple and practical scale that evaluates patient prognosis upon admission and is used widely to predict the outcome and stratify patients. Another scale, which was developed based on large epidemiologic studies, the EMSE, is more easily adapted to different regions around the world when assessing individual risk and stratifying patients in interventional studies. The mSTESS was created by adding the modified Rankin Scale (mRS) to the STESS, which decreases the ceiling effect and increases the mortality prediction capabilities of the STESS. The END-IT is the only prognostic scale assessing functional outcome and is comprehensively simple and satisfyingly accurate. Evaluating the limitations of each of these scales aids in the exploration and advancement of SE prognostic scales, thereby facilitating better clinical interventions and scientific research.

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“…Epilepsy likewise represents another neurological disorder with significant societal and economic consequences, as well as medical [177][178][179][180][181][182][183][184][185][186][187][188][189][190]. Treatments for epilepsy have been available for many years; a recent study on the long term prognosis of epilepsy found 59% of patients were seizure free, with a progressive increase in remission over time [184].…”

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confidence: 99%