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

Abstract

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.

Prediction of Postictal Delirium Following Status Epilepticus in the ICU: First Insights of an Observational Cohort Study

“…As described earlier (14,(35)(36)(37)(38), SE duration was defined as the time between the first clinical and/or electroencephalographic evidence of seizure and seizure termination on electroencephalograph. As our monitoring unit used two different electroencephalographic strategies, such as continuous or spot electroencephalographs of greater than or equal to 30 minutes every 12 hours, SE duration represents a 12-hour approximation.…”

Early timing of anesthesia in status epilepticus is associated with complete recovery: A 7‐year retrospective two‐center study

“…Furthermore, the illness severity scoring systems Simplified Acute Physiology Score II (SAPS II) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were unavailable for a substantial number of patients on the first day of SE, a shortcoming that is at least partially compensated for by correcting for the Charlson Comorbidity Index and the STESS, both well‐established and validated scoring systems. In addition, although both the SAPS II and APACHE II facilitate benchmarking and comparisons of cohorts of severely ill patients, they offer no advantages over the STESS and the Glasgow Coma Scale regarding prediction of no return to baseline 34 . Finally, there may be an unrecognized selection bias from confounding factors or scenarios that may have led attending physicians to induce anesthesia early or to do the opposite (i.e., to avoid or postpone anesthesia in patients thought to be too critical for anesthesia), which we could not account for.…”

“…In addition, although both the SAPS II and APACHE II facilitate benchmarking and comparisons of cohorts of severely ill patients, they offer no advantages over the STESS and the Glasgow Coma Scale regarding prediction of no return to baseline. 34 Finally, there may be an unrecognized selection bias from confounding factors or scenarios that may have led attending physicians to induce anesthesia early or to do the opposite (i.e., to avoid or postpone anesthesia in patients thought to be too critical for anesthesia), which we could not account for. Patients more suitable for continuous infusions may have received these sooner than patients in nonmonitored units or developing SE during their hospital stay outside the ICUs.…”

Comparing Patients With Isolated Seizures and Status Epilepticus in Intensive Care Units

“…Definition, Duration, and Severity of SE SE was diagnosed and defined according to the ILAE 19 and specific specifical types of SE were categorized as focal nonconvulsive without coma (with or without altered consciousness), with motor symptoms including myoclonic and convulsive types, and nonconvulsive SE with coma. As outlined in our previous studies, 13,16,[20][21][22] the duration of SE was defined as the time between clinical and/or EEG evidence of start of seizures and seizure termination as verified by EEG. SE duration in our studies represents an approximation of 12 hours at most, as during the study period our monitoring unit used 2 types of EEG (continuous EEG monitoring or spot video-EEGs ≥30 minutes at least twice every 24 hours) in patients with nonrefractory SE and continuous video-EEG in all patients with treatment-refractory SE.…”