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

Abstract

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.

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

“…Moreover, as reported first on arterial spin labeling sequence on MRI by Ohtomo et al [24] and recently on pCT by Giovannini et al [22], thalamic hyperperfusion, although not sensitive, is highly specific of continuous sustained ictal activity compatible with SE on EEG. Therefore, the present study suggests that early pCT findings, together with other factors, such as clinical presentation [25], could serve as an adjunctive diagnostic tool for NCSE risk stratification; thus, probably avoiding delayed management in acute settings, especially if accompanied by the highly specific feature of thalamic hyperperfusion. Reliable prospective data have shown that pCT performed within 80 min of the end of a seizure shows postictal hypoperfusion in 80% of patients with epilepsy [26].…”

Predictors of mortality at one year after generalized convulsive status epilepticus

“…Electroencephalogram (EEG) is not available in EMS, and 24/7 EEG-recording possibilities are lacking in most of the EDs. Therefore, the diagnosis of SE in the early [34]; however, substantial effort should be accomplished to improve the diagnostic facilities.…”

Recognition and treatment of status epilepticus in the prehospital setting

“…This scale consists of 6 clinical items (i.e. abnormal speech, eye deviation, automatism, hemiparesis, state of stupor or coma and number of prehospital seizures) and had a sensitivity of 98.7 % with a specificity of 85.4 % according to the validation study [21].…”