Development of a novel outcome prediction score (PEDSS) for pediatric convulsive status epilepticus: A longitudinal observational study

Abstract

Objective: The objectives of this study were to evaluate ENDIT score and develop a novel outcome prediction score for outcome of pediatric convulsive status epilepticus (CSE) at the hospital and 3 months postdischarge. Methods: Children and adolescents aged 1 month to 14 years, presenting with CSE to a tertiary care teaching center in North India from January 2017 to March 2019, were screened for enrollment. In-hospital and 3-month postdischarge outcome were defined as poor if Pediatric Cerebral Performance Category Scale (PCPCS) score dropped by ≥2 levels. Results: Overall, 61 patients were enrolled for final analysis after applying exclusion and inclusion criteria. The area under the receiver operating characteristic (ROC) curve for ENDIT score in predicting mortality and differentiating good from poor outcome at the hospital and at 3 months postdischarge was 0.74 (95% confidence interval [CI] = 0.58-0.89), 0.7 (95% CI = 0.57-0.83), and 0.72 (95% CI = 0.6-0.82), respectively. Based on predictors in the present cohort that were significantly different between good and poor outcome cases at the hospital and 3 months postdischarge, a new six-point score named PEDSS (pre-status epilepticus PCPCS, background electroencephalographic abnormalities, drug refractoriness, semiology, and critical sickness) was developed. The area under ROC curves for PEDSS score in predicting mortality and differentiating good from poor outcome at the hospital and at 3 months postdischarge were 0.93 (95% CI = 0.87-0.99), 0.8 (95% CI = 0.7-0.9), and 0.89 (95% CI = 0.8-0.96), respectively. The best cutoff PEDSS scores for predicting mortality and poor outcome at the hospital and at 3 months postdischarge were ≥4, ≥3, and ≥3, respectively.

The prognostic factors in children with status epilepticus & status epilepticus severity score scales

“…We should wait to evaluate the response to the treatment and whether there is organ failure during management. According to the study by Tiwari et al, the cut-off PEDSS scores for mortality and poor outcome at the hospital and 3 months post-discharge were ≥ 4, ≥3, and ≥ 3, respectively (12). In our study, the cut-off for poor prognosis was ≥ 3 at the hospital before discharge and 6 for mortality.…”

“…Demographic and clinical variables comprised of age, gender, age of onset of SE, type of seizure, etiology, genetic analysis results( available ones), EEG results, magnetic resonance imaging (MRI,) results, and scores of Pre-status epilepticus Pediatric Cerebral Performance Category Scale PCPCS, background electroencephalographic abnormalities EEG, Drug refractoriness, Semiology, and Critical Sickness ( PEDSS) and modi ed Status Epilepticus Severity Score (mSTESS), treatments received, responses to treatments, developmental status at baseline before SE and after SE before discharge at the last available follow-up visit, mortality were recorded ( 11,12). The diagnosis of SE was made according to the ILAE 2015 classi cation.…”

“…Refractory SE was de ned as SE persisting despite the administration of two appropriate anticonvulsants (BZD and phenytoin) at acceptable doses and responding only to third-line ASM as midazolam infusion or anesthetic agent infusion. Super-refractory SE was de ned as SE that continued 24 h or more even after the onset of anesthesia infusion, including those cases in which the SE recurred on the reduction or withdrawal of anesthesia (11)(12)(13)(14)(15)). The patients were followed till discharge or death.…”

“…An increase by one, two, or more levels. of disability score, inhospital was considered a poor outcome, whereas no worsening or worsening was considered a good outcome (11,12). ---------------------------------------------------…”

Epileptic Status in a PEDiatric cohort (ESPED) requiring intensive care treatment: A multicenter, national, two‐year prospective surveillance study

“…20 We used the modified Rankin and PEDSS scales to assess disease severity and outcome. 21,22 The main research questions assessed:…”