Journal of Neurology

, Volume 255, Issue 10, pp 1561–1566

Status Epilepticus Severity Score (STESS)

A tool to orient early treatment strategy
  • Andrea O. Rossetti
  • Giancarlo Logroscino
  • Tracey A. Milligan
  • Costas Michaelides
  • Christiane Ruffieux
  • Edward B. Bromfield
ORIGINAL COMMUNICATION

DOI: 10.1007/s00415-008-0989-1

Cite this article as:
Rossetti, A.O., Logroscino, G., Milligan, T.A. et al. J Neurol (2008) 255: 1561. doi:10.1007/s00415-008-0989-1
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Abstract

Background

Status epilepticus (SE) treatment ranges from small benzodiazepine doses to coma induction. For some SE subgroups, it is unclear how the risk of an aggressive therapeutic approach balances with outcome improvement. We recently developed a prognostic score (Status Epilepticus Severity Score, STESS), relying on four outcome predictors (age, history of seizures, seizure type and extent of consciousness impairment), determined before treatment institution. Our aim was to assess whether the score might have a role in the treatment strategy choice.

Methods

This cohort study involved adult patients in three centers. For each patient, the STESS was calculated before primary outcome assessment: survival vs. death at discharge. Its ability to predict survival was estimated through the negative predictive value for mortality (NPV). Stratified odds ratios (OR) for mortality were calculated considering coma induction as exposure; strata were defined by the STESS level.

Results

In the observed 154 patients, the STESS had an excellent negative predictive value (0.97). A favorable STESS was highly related to survival (P < 0.001), and to return to baseline clinical condition in survivors (P < 0.001). The combined Mantel-Haenszel OR for mortality in patients stratified after coma induction and their STESS was 1.5 (95 % CI: 0.59–3.83).

Conclusion

The STESS reliably identifies SE patients who will survive. Early aggressive treatment could not be routinely warranted in patients with a favorable STESS, who will almost certainly survive their SE episode. A randomized trial using this score would be needed to confirm this hypothesis.

Key words

status epilepticus prognosis treatment coma induction outcome 

Copyright information

© Springer 2008

Authors and Affiliations

  • Andrea O. Rossetti
    • 1
  • Giancarlo Logroscino
    • 2
  • Tracey A. Milligan
    • 3
  • Costas Michaelides
    • 4
  • Christiane Ruffieux
    • 5
  • Edward B. Bromfield
    • 3
  1. 1.Service de NeurologieCHUV-BH07LausanneSwitzerland
  2. 2.Harvard School of Public HealthBostonUSA
  3. 3.Dept. of NeurologyBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Dept. of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  5. 5.Institut de Médecine Sociale et Préventive Centre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland

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