Evaluation of prognostic scores for status epilepticus in the neurology ICU: A retrospective study

• Published in: Journal of the neurological sciences 2024-04, Vol.459, p.122953-122953, Article 122953
• Main Authors: Shen, Jia Yi, Saffari, Seyed Ehsan, Yong, Linda, Tan, Nigel Choon Kiat, Tan, Yee-Leng
• Format: Article
• Language: English
• Subjects: Critical care; Humans; Intensive Care Units; Prognosis; Retrospective Studies; Severity of Illness Index; Status epilepticus; Status Epilepticus - diagnosis
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2024.122953

Status epilepticus (SE) in the neurology intensive care unit (ICU) is associated with significant morbidity. We aimed to evaluate the utility of existing prognostic scores, namely the Status Epilepticus Severity Score (STESS), Epidemiology Based Mortality Score in Status Epilepticus (EMSE)-EACE and Encephalitis-Nonconvulsive Status Epilepticus-Diazepam Resistance-Image Abnormalities-Tracheal Intubation (END-IT), among SE patients in the neurology ICU. Neurology ICU patients with SE requiring continuous electroencephalography (cEEG) monitoring over a 10 year period were included. The STESS, EMSE-EACE and END-IT scores were applied retrospectively. Receiver operating characteristic (ROC) analysis was performed to assess the discriminatory value of the scores for inpatient mortality and functional decline, as measured by increase in the modified Rankin Scale (mRS) on discharge. Eighty-five patients were included in the study, of which 71 (83.5%) had refractory SE. Inpatient mortality was 36.5%. Sixty – seven (78.8%) of patients suffered functional decline, with a median mRS of 5 upon hospital discharge. The AUCs of the STESS, EMSE-EACE and END-IT scores associated with inpatient mortality were 0.723 (95% CI 0.613–0.833), 0.722 (95% CI 0.609–0.834) and 0.560 (95% CI 0.436–0.684) respectively. The AUCs of the STESS, EMSE-EACE and END-IT scores associated with functional decline were 0.604 (95% CI 0.468–0.741), 0.596 (95% CI 0.439–0.754) and 0.477 (95% CI 0.331–0.623). SE was associated with high mortality and morbidity in this cohort of neurology ICU patients requiring cEEG monitoring. The STESS and EMSE-EACE scores had acceptable AUCs for prediction of inpatient mortality. However, the STESS, EMSE-EACE and END-IT were poorly-correlated with discharge functional outcomes. Further refinements of the scores may be necessary among neurology ICU patients for predicting discharge functional outcomes. •Status epilepticus (SE) in the neurology ICU carries a high morbidity and mortality.•STESS and EMSE-EACE scores were correlated with inpatient mortality in this cohort of patients.•Existing prognostic scores did not predict functional outcomes among SE patients in the ICU.•Further refinements of the scores may be necessary for prediction of functional outcomes.