Background
Methods
Setting
Definition of SE
Data collection and scoring of SE
Outcome
Statistics
Results
Demographics
Total (n = 120) | |
---|---|
Gender (female, %) | 56 (46.7 %) |
Age (years, median (range)) | 63.5 (20–91) |
Age (>65 years) | 57 (47.5 %) |
Etiology of SE | |
Acute symptomatic | 50 (41.7 %) |
Remote symptomatic | 44 (36.7 %) |
Progressive symptomatic | 9 (7.5 %) |
Idiopathic/cryptogenic | 17 (14.2 %) |
SE dynamics | |
Generalized convulsive SE only | 39 (32.5 %) |
Non-convulsive SE | 50 (41.7 %) |
Generalized convulsive SE evolving into non-convulsive SE | 19 (15.8 %) |
Absence SE | 1 (0.8 %) |
First episode of SE | 106 (88 %) |
Refractory SE | 28 (23.3 %) |
LOC pretreatment | |
Awake or somnolent/confused | 56 (46.7 %) |
Stuporous or comatose | 64 (53.3 %) |
Worst seizure type | |
Simple partial, CPS, absence, myoclonic | 48 (40.0 %) |
Generalized convulsive | 48 (40.0 %) |
Non-convulsive SE in coma | 24 (20.0 %) |
History of previous epilepsy | 77 (64.2 %) |
Duration of pretreatment (>1 hour) | 88 (73.3 %) |
Duration of seizure | |
>5 min, <30 min | 10 (8.3 %) |
3 min or longer, but <1 hour | 15 (12.5 %) |
1 hour or longer | 95 (79.2 %) |
Charlon’s Comorbidity index total | |
0 | 33 (27.5 %) |
1–2 | 41 (34.1 %) |
3 or more | 46 (38.4 %) |
EEG–BS | 23 (19.2 %) |
PDs | 65 (54.2 %) |
Treated on NICU | 57 (47.5 %) |
Days on NICU (median (range)) | 8 (1–125) |
Performance of the STESS and EMSE in predicting in-hospital death
AUROC (cutoff point) | Sensitivity | Specificity | NPV | PPV | Accuracy | |
---|---|---|---|---|---|---|
EMSE-EAC | 0.633 (>37) | 0.17 | 0.92 | 0.47 | 0.75 | 0.51 |
EMSE-ECEg | 0.750 (>71) | 0.81 | 0.56 | 0.95 | 0.22 | 0.59 |
EMSE-ELEg | 0.764 (>47) | 1.00 | 0.46 | 1.00 | 0.22 | 0.53 |
EMSE-LDEg | 0.744 (>47) | 0.21 | 1.00 | 0.40 | 1.00 | 0.48 |
EMSE-EACEg | 0.712 (>62) | 0.94 | 0.44 | 0.98 | 0.21 | 0.51 |
EMSE-EALEg | 0.771 (>54) | 1.00 | 0.47 | 1.00 | 0.22 | 0.54 |
EMSE-ECLEg | 0.745 (>81) | 0.81 | 0.63 | 0.96 | 0.25 | 0.66 |
EMSE-ELDEg | 0.766 (>75) | 0.23 | 1.00 | 0.47 | 1.00 | 0.59 |
EMSE-ALDEg | 0.745 (>60) | 0.22 | 1.00 | 0.44 | 1.00 | 0.52 |
STESS | 0.673 (≥4) | 0.56 | 0.70 | 0.91 | 0.22 | 0.68 |
Prediction of functional outcome at discharge based on the EMSE and STESS
AUROC (cutoff point) | Sensitivity | Specificity | NPV | PPV | Accuracy | |
---|---|---|---|---|---|---|
EMSE-ECEg | 0.777 (>51) | 0.82 | 0.60 | 0.73 | 0.72 | 0.73 |
EMSE-ECLEg | 0.793 (>77) | 0.72 | 0.75 | 0.68 | 0.79 | 0.73 |
EMSE-ALDEg | 0.747 (>58) | 0.73 | 0.74 | 0.60 | 0.84 | 0.73 |
STESS | 0.610 (≥4) | 0.81 | 0.44 | 0.54 | 0.75 | 0.61 |
Discussion
Prediction of in-hospital mortality
Prediction of functional outcome
Strengths and limitations
Conclusion
Key messages
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This is the first independent, external, validation study of the predictive accuracy of STESS and EMSE score using a multicenter prospective cohort.
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There was no statistically significant difference between the predictive power of two scoring system regarding in-hospital mortality.
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It is possible to predict functional outcome and in-hospital death using the EMSE score, simultaneously.
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The STESS was significantly less useful in predicting the functional outcome.
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The optimized cutoff value of STESS could be at greater than or equal to 4 points to predict in-hospital death.