Distinguishing in‐hospital and out‐of‐hospital status epilepticus: clinical implications from a 10‐year cohort study

Sutter, Raoul; Semmlack, Saskia; Spiegel, Rainer; Tisljar, Kai; Rüegg, Stephan; Marsch, Stephan

doi:10.1111/ene.13359

Cited by 25 publications

(25 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As described previously, SE duration was defined as the time span between the clinical and/or EEG evidence of seizure onset and the time point at which seizure termination was revealed by EEG. As in our institution, 2 different EEG recording strategies are used such as continuous EEG or spot EEGs of ≥30 minutes every 12 hours; SE duration is expressed as an approximation with an inaccuracy of 12 hours at most.…”

Section: Methodsmentioning

confidence: 99%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

Self Cite

View full text Add to dashboard Cite

Objectives: Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at seizure onset and to identify patients with high chances for full recovery. Methods: From 2005 to 2016, all adult SE patients treated at the University Hospital Basel, a Swiss medical care center, were included. Multivariable Poisson regression was performed to identify predictors of prolonged SE (defined as SE for >12, >24, and >48 hours) and return to baseline from prolonged SE. The area under the receiver-operating characteristic curves (AUROC) for prediction models was calculated. Results: Of 467 patients, the median age was 66.7 years and mortality was 12%.Relative risk (RR) for death was 1.06 (P < 0.0001) with every SE day. In multivariable analysis, nonconvulsive SE with coma, SE severity score ≥3, and acute brain lesions at SE onset independently predicted prolonged SE with an AUROC of 0.68 for >12, 0.67 for >24, and 0.72 for >48 hours of SE. Absence of nonconvulsive SE with coma and a decreasing Charlson comorbidity index were independent predictors for return to baseline in prolonged SE with an AUROC of 0.82 and 0.76 following cross-validation. Both associations remained significant despite adjustments for determinants of adverse outcome, such as anesthetics and vasopressors (nonconvulsive SE with coma RR = 0.24, 95% confidence interval [CI] 0.07-0.86; comorbidity index RR = 0.87, 95% CI 0.76-0.99). Significance: Although our data indicate that identification of prolonged SE at seizure onset is unreliable, timely recognition of patients with high chances of good outcome despite prolonged SE is promising on the basis of comorbidities, type of SE, and level of consciousness. Further external validation of this prediction model is needed.

show abstract

Section: Methodsmentioning

confidence: 99%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…The ADAN scale to identify patients at risk of having SE has been contemplated for out‐of‐hospital use, but it would be interesting to assess its performance in other clinical situations, such as patients with altered mental status or acute focal deficits without evidence of previous epileptic seizure and in‐hospital SE. The prognosis of these patients is poorer than that of patients with SE detected out of hospital .…”

Section: Discussionmentioning

confidence: 79%

The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus

Requena

Fonseca

Olivé

et al. 2019

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose The prognosis of status epilepticus (SE) depends on the time between onset and the diagnosis and start of treatment. Our aim was to design a scale with predictive value for pre‐hospital diagnosis of SE. Methods This was a retrospective study of 292 patients who attended the emergency department for an epileptic seizure. A total of 49 patients fulfilled the criteria for SE. We recorded the patients’ history and clinical features. Variables independently associated with SE were combined to design a clinical scale. The performance of the scale was evaluated in a validation dataset of 197 patients. Results A total of 50.3% of the patients were male and the mean age was 55.9 years. The following features were more prevalent in patients with SE: abnormal speech (79.6% vs. 18.9%, P < 0.001), eye deviation (69.4% vs. 14.0%, P < 0.001), automatism (22.4% vs. 6.3%, P < 0.001), hemiparesis (24.5% vs. 10.9%, P = 0.011), state of stupor/coma (46.9% vs. 4.2%, P < 0.001) and number of pre‐hospital seizures, i.e. two (34.7% vs. 4.5%, P < 0.001) or more than two (51.0% vs. 0.4%, P < 0.001). Based on these findings, we designed a scale that scored 1 point each for presence of abnormal speech, eye deviation, automatism and two seizures, and 2 points for more than two seizures. The predictive capacity of the scale for identifying SE in the validation dataset was 98.7% (95% confidence interval, 97.3%–100%) and 85.4% of patients with a score >1 had SE. Conclusions A score >1 on the ADAN scale is a robust predictor of the diagnosis of SE in patients who experience an epileptic seizure. This scale may be a useful tool for clinical use and warrants further investigation.

show abstract

“…Nonconvulsive SE was defined as clinical and/or electroencephalographic (EEG) evidence of seizures for >30 minutes, or as series of seizures without complete interictal clinical recovery. SE duration was defined as the time period between diagnosis and EEG‐proven SE cessation . SE duration represents an approximation with a maximal inaccuracy of 12 hours, as either continuous EEG or spot EEGs of ≥30 minutes recorded every 12 hours were performed.…”

Section: Methodsmentioning

confidence: 99%

“…SE duration was defined as the time period between diagnosis and EEG-proven SE cessation. 17,18 SE duration represents an approximation with a maximal inaccuracy of 12 hours, as either continuous EEG or spot EEGs of ≥30 minutes recorded every 12 hours were performed.…”

Section: Se Definition and Durationmentioning

confidence: 99%

Illness severity scoring in status epilepticus—When STESS meets APACHE II, SAPS II, and SOFA

et al. 2018

Self Cite

View full text Add to dashboard Cite

Summary Objective To characterize a critically ill cohort with status epilepticus (SE) by the illness severity scoring systems SAPS II (Simplified Acute Physiology Score II), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SOFA (Sequential Organ Failure Assessment), and to compare their performance with the STESS (Status Epilepticus Severity Score) for outcome prediction. Methods The prospective cohort study was carried out at the University Hospital Basel, a Swiss tertiary academic medical care center. Consecutive adult SE patients hospitalized in the intensive care units from 2011 to 2016 were included. Illness severity scores and additional clinical data were recorded. Logistic regression models using automated variable selection were applied to identify scores associated with no return to functional and neurological baseline and death. Measures of discrimination and calibration were assessed. Results Among 184 patients, 33% returned to baseline. Median scores of the illness severity scores were within the lowest third of the possible scoring ranges, and all differed significantly between patients with and without return to baseline. The areas under the receiver operating curves for the prediction of no return to baseline and death ranged from 0.64 to 0.73, with the highest value for the STESS predicting no return to baseline. Measures of calibration revealed adequate model fit for all analyses. Among integral components of the scoring systems, only the Glasgow Coma Scale (GCS) differed significantly between patients with and without return to baseline. In multivariable analyses, decreasing GCS and increasing STESS had the strongest associations (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.77‐0.93 and OR = 1.34, 95% CI = 1.05‐1.68, respectively) with no return to baseline independent of all other scoring systems, whereas the APACHE II revealed the strongest association with death (OR = 1.15, 95% CI = 1.06‐1.25). Significance Although complex illness severity scoring systems in SE patients facilitate benchmarking and comparisons with other severely ill patient cohorts, they offer no advantages over the STESS and GCS regarding prediction of no return to baseline.

show abstract

Distinguishing in‐hospital and out‐of‐hospital status epilepticus: clinical implications from a 10‐year cohort study

Cited by 25 publications

References 42 publications

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus

Illness severity scoring in status epilepticus—When STESS meets APACHE II, SAPS II, and SOFA

Contact Info

Product

Resources

About