Prognostic value of Salzburg nonconvulsive status epilepticus criteria: The SACE score

Abstract

ObjectiveTo investigate the association between NCSE Salzburg criteria and in‐hospital outcome, to determine the predictive accuracy of STESS, mSTESS, EMSE and END‐IT in NCSE patients and to develop a new prognostic score specifically designed for NCSE patients.MethodsClinical and EEG data of adult patients treated for NCSE from 2020 to 2023 were retrospectively assessed. Age, sex, mRS at admission, comorbidities, history of seizures, etiology, SE type and outcome were collected from the patients’ digital charts. EEG data were assessed and categorized applying the Salzburg NCSE Criteria. In‐hospital death was defined as the primary outcome.Results116 NCSE patients were included. Multivariable logistic regression revealed that the Salzburg NCSE criterion A2 (ictal morphological, spatial, and temporal evolution) was associated with in‐hospital survival. The best STESS cut‐off was ≥4 (sensitivity 0.62, specificity 0.69, accuracy 67%). mSTESS≥5 reached a sensitivity of 0.68, a specificity of 0.57, and an overall accuracy of 60%, EMSE≥64 a sensitivity of 0.82, a specificity of 0.39, and an overall accuracy of 52%, END‐IT≥3 a sensitivity of 0.65, a specificity of 0.44, and an overall accuracy of 50%.Through a hypothesis generating approach we developed the SACE score, which integrates EEG features (criterion A2) to patient age (with a 75‐years cutoff), history of seizure and level of consciousness. With a cutoff of ≥ 3, it had a sensitivity of 0.77, a specificity of 0.74, and an overall accuracy of 76%, performing better than other prognostic scores.SignificanceWe developed a new user‐friendly scoring system, the SACE score, which integrates EEG features to other established outcome‐related variables assessable in early stages, to assist neurologists and neurointensivists in making more tailored prognostic decisions for NCSE patients.