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Status Epilepticus Severity Score (STESS)

A tool to orient early treatment strategy

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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.

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Author information

Authors and Affiliations

  1. Service de Neurologie, CHUV-BH07, 1011, Lausanne, Switzerland

    Andrea O. Rossetti

  2. Harvard School of Public Health, Boston, MA, USA

    Giancarlo Logroscino MD, PhD

  3. Dept. of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Tracey A. Milligan MD & Edward B. Bromfield MD

  4. Dept. of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Costas Michaelides MD

  5. Institut de Médecine Sociale et Préventive Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    Christiane Ruffieux PhD

Authors
  1. Andrea O. Rossetti
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  2. Giancarlo Logroscino MD, PhD
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  3. Tracey A. Milligan MD
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  4. Costas Michaelides MD
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  5. Christiane Ruffieux PhD
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  6. Edward B. Bromfield MD
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Corresponding author

Correspondence to Andrea O. Rossetti.

Additional information

This paper was presented in part at the 61st Annual Meeting of the American Epilepsy Society, Nov. 30–Dec. 4, 2007, in Philadelphia, PA, USA.

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Rossetti, A.O., Logroscino, G., Milligan, T.A. et al. Status Epilepticus Severity Score (STESS). J Neurol 255, 1561–1566 (2008). https://doi.org/10.1007/s00415-008-0989-1

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  • DOI: https://doi.org/10.1007/s00415-008-0989-1

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