Prognostic scores in status epilepticus: A systematic review and meta‐analysis

Abstract

The performance of prognostic scores of status epilepticus (SE) has been reported in very heterogeneous cohorts. We aimed to provide a summary of the available evidence on their respective performance. PubMed and EMBASE were searched for relevant articles. Studies were reviewed for eligibility for meta‐analysis of the area under the receiver‐operating characteristic curve (AUC) and for meta‐analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting in‐hospital mortality with scores in which at least two external evaluations had been published. This study was registered with PROSPERO (international prospective register of systematic reviews) (CRD42022325766). Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). In the meta‐analysis of AUC, 21 studies were pooled for STESS (Status Epilepticus Severity Score), five for EMSE‐EAC (Epidemiology‐based Mortality Score in Status Epilepticus ‐ Etiology, Age, level of Consciousness), five for EMSE‐EACE (EMSE ‐ Etiology, Age, level of Consciousness, EEG), and two for ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation). The pooled AUC of STESS, EMSE‐EAC, EMSE‐EACE, and ENDIT was 0.74 (95% CI: 0.71–0.78), 0.68 (95% CI 0.63–0.72), 0.77 (95% CI: 0.72–0.81), and 0.78 (95% CI: 0.70–0.87), respectively. The pooled sensitivity of STESS‐3, STESS‐4, EMSE‐EACE‐64, and ENDIT‐4 was 0.83 (95% CI: 0.80–0.86), 0.60 (95% CI: 0.55–0.65), 0.76 (95% CI: 0.67–0.83), and 0.70 (95% CI: 0.55–0.82), respectively. Their pooled specificity was 0.50 (95% CI: 0.48–0.52), 0.74 (95% CI: 0.72–0.76), 0.63 (95% CI: 0.59–0.67), and 0.65 (95% CI: 0.61–0.70), respectively. Their pooled PPV was 0.27 (95% CI: 0.24–0.30), 0.35 (95% CI: 0.29–0.41), 0.33 (95% CI: 0.24–0.43), and 0.20 (95% CI: 0.13–0.27). Their pooled NPV was 0.94 (95% CI: 0.93–0.96), 0.90 (95% CI: 0.89–0.92), 0.89 (95% CI: 0.80–0.98), and 0.95 (95% CI: 0.92–0.98). Variations in performance were observed in patients' subgroups, such as critically ill patients and refractory cases. Investigated scores only have acceptable AUC, sensitivity, and specificity for predicting in‐hospital mortality, with the EMSE‐EAC having a lower discriminative power. STESS‐3 has the highest sensitivity, and STESS‐4 the highest specificity, but neither combines acceptable sensitivity and specificity. All these scores had high NPV but very low PPV. Caution should be exercised in their clinical use. Further studies are required to develop more accurate scores.

Nonconvulsive status epilepticus in neurocritical care: A critical reappraisal of outcome prediction scores

“…Yet, similar to our results, the performance of these scores (aside from describing a cohort) exhibits significant divergence among various cohorts. Yuan et al 11 performed a meta‐analysis providing pooled AUCs for STESS (.741, range = .574–.864), EMSE (.765, range = .636–.860), and END‐IT (.783, range = .659–.843) when predicting in‐hospital mortality. When considering the development of scores, however, the original study generally outperforms its competitors and validation studies when considering its own dataset.…”

“…These include Status Epilepticus Severity Score (STESS), 7,8 Epidemiology‐Based Mortality Score in Status Epilepticus (EMSE), 9 and END‐IT (including the predictors encephalitis, NCSE, diazepam resistance, imaging features, and tracheal intubation, which form the acronym) 10 . STESS, EMSE, and to a lesser degree END‐IT (due to its more recent development) have been validated for various patient cohorts 11 . These include descriptions in different countries, 12–14 different age groups, 15,16 and some intensive care unit populations 17,18 .…”

“…10 STESS, EMSE, and to a lesser degree END-IT (due to its more recent development) have been validated for various patient cohorts. 11 These include descriptions in different countries, [12][13][14] different age groups, 15,16 and some intensive care unit populations. 17,18 A validation of their utility including only patients with need for NCCU and only NCSE has to our best knowledge been unavailable until now.…”

Magnetic Resonance Imaging in Status Epilepticus: Useful Scrying Board or Expensive Stopwatch?

“…Currently available clinical scores lack accuracy. 7 In Bonduelle et al, the presence of PMA was not associated with higher status epilepticus severity scores, the most frequently used score, but it was associated with mortality, even when accounting for age and etiology, two components of most SE severity scores. In Cornwall et al, the association of PMA with mortality was significant, even when adjusting for the epidemiology-based mortality in SE score.…”

Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury

“…13 However, a recent meta-analysis assessing prognostic scores developed for use in SE (including EMSE and STESS) showed that while all scores had high negative predictive values (0.89-0.95), their positive predictive values were quite low (0.2-0.35) indicating that the likelihood of correctly identifying survival following SE is high, but ability to accurately detect mortality is low. 14 Therefore, caution should be used when applying these scores.…”