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Epidemiology-Based Mortality Score in Status Epilepticus (EMSE)

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Abstract

Background

Status epilepticus (SE) is a neurological emergency with high mortality and often a poor functional outcome amongst survivors. So far, only status epilepticus severity score (STESS) is available to predict individual outcomes. STESS is based on weighted sum scores of age, type of seizure, level of consciousness and history of previous seizures. Weighting factors were based on a priori assumptions.

Methods

We tested in an explorative, hypothesis generating approach, whether epidemiological data (i.e. mortality rates) can be combined to form a score (Epidemiology-based Mortality score in SE—EMSE), and further, which combination of aetiology, age, comorbidity, EEG, duration and level of consciousness yields highest test performance. Positive and negative predictive value, and correctly classified were compared to STESS (with different cut-off levels: STESS-3, STESS-4). Score points for each parameter, e.g. age, were derived from previously published specific mortality rates. For each combination of parameters, the lowest sum-score of deceased individuals was taken as cut-off. Ninety-two consecutive non-hypoxic patients (age range 20–90 years), with various forms of SE admitted to a tertiary care neurological intensive care unit were investigated retrospectively.

Results

EMSE using a combination of aetiology, age, comorbidity and EEG (NPV = 100 %, PPV = 68.8 %, correctly classified 89.1 %) was superior to STESS-3 and STESS-4 (p = 0.0022 or lower).

Conclusion

EMSE explained individual mortality in almost 90 % of cases, and performed significantly better than previous scores. This explorative study needs external prospective corroboration. EMSE may be a valuable tool for risk stratification in interventional studies in the future.

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Acknowledgments

We would like to thank all medical staff of emergency room and neurological intensive care unit at Paracelsus Medical University Salzburg, Austria, for taking best care of their patients. Furthermore, we want to thank Patrick B. Langthaler and Kevin HG. Butz for help in creating figures and to Prof. Arne Bathke for statistically reviewing this work.

Conflict of interests

Eugen Trinka has acted as a paid consultant to Eisai, Ever Neuropharma, Biogen Idec, Medtronics, Bial and UCB and has received speakers’ honoraria from Bial, Eisai, GL Pharma, GlaxoSmithKline, Boehringer, Viropharma, Actavis and UCB Pharma in the past 3 years. Eugen Trinka has received research funding from UCB Pharma, Biogen-Idec, Red Bull, Merck, the EU, FWF Österreichischer Fond zur Wissenschaftsförderung and Bundesministerium für Wissenschaft und Forschung. Eugen Trinka is also one of the investigators planning ESETT (Established Status Epilepticus Treatment Trial). Julia Höfler has received speakers’ honoraria from UCB Pharma and travel support from Eisai and GL Pharma. Markus Leitinger has received a travel Grant from Medtronic. Yvonne Höller, Gudrun Kalss, Alexandra Rohracher, Helmut F Novak, Judith Dobesberger, and Giorgi Kuchukhidze have no conflicts of interest to declare.

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Leitinger, M., Höller, Y., Kalss, G. et al. Epidemiology-Based Mortality Score in Status Epilepticus (EMSE). Neurocrit Care 22, 273–282 (2015). https://doi.org/10.1007/s12028-014-0080-y

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