Evaluation of STESS, mRSTESS, and EMSE to Predict High Disability and Mortality at Hospital Discharge in Ecuadorian Patients with Status Epilepticus
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Adequate identification of the severity of status epilepticus (SE) contributes to individualized treatment. The scales most widely used for this purpose are: Status Epilepticus Severity Score (STESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) and modified Rankin Scale STESS (mRSTESS). The aim of this study was to evaluate the performance of the STESS, EMSE and mRSTESS scales to predict high disability and hospital mortality at discharge (HD/HM).
A prospective study was conducted in which total of 41 patients were registered from November 2015 to January 2018 at Eugenio Espejo Hospital. Clinical variables such as age, sex, clinical status at the beginning of the SE, initial symptom of SE, as well as the STESS, mRSTESS and EMSE variant scales were studied at the time of the diagnosis of SE.
A total of 41 patients were evaluated, of which 8 (19.5%) had HD at hospital discharge and died 13 (31.7%) during their care. The area under the receiver operating characteristic curve to predict HD/HM was 0.71 (95% CI (confidence interval) 0.55–0.87), 0.81 (95% CI 0.67–0.94), 0.89 (95% CI 0.79–0.99), 0.90 (95% CI 0.80–1.0), 0.89 (95% CI 0.78–0.99) for the STESS, mRSTESS, EMSE-EAC (etiology, age, comorbidities), EMSE-EACEG (etiology, age, comorbidities, electroencephalography) and EMSE-ECLEG (etiology, age, level of consciousness at pre-treatment, electroencephalography), variants of EMSE, respectively. The binary logistic regression demonstrated how the following cut-off points were determined: STESS OR (odd ratio) 4.80 (p = 0.02), mRSTESS OR 7.89 (p = 0.00), EMSE-EAC OR 22.16 (p = 0.00), EMSE-ECLEG OR 18.00 (p = 0.00), EMSE-EACEG OR 14 (p = 0.00).
All of the evaluated scales (STESS, mRSTESS, and EMSE) were shown to be useful in predicting HD/HM. EMSE was observed to be the most effective of the scales, with relative similarities among the variants.
KeywordsSTESS mRSTESS EMSE Status epilepticus Mortality High disability
DRR designed the study, collected and processed the data, performed the statistical analyses, and drafted the manuscript. CSM participated in treatment of the patients, collected the data, and reviewed the final manuscript. KS drafted the manuscript and performed the analysis of the results. DDS participated in treatment of the patients, collected the data, and reviewed the final manuscript. NMS obtained institutional permissions to carry out the study, participated in treatment of the patients, and reviewed the final manuscript. YP performed the statistical analyses.
Source of support
This research received no external funding.
Compliance with Ethical Standards
Conflict of interest
The authors declare there were no conflicts of interest.
The execution and publication of this study was approved by the ethical committee of the institution.
Informed consent was obtained from all individual participants included in the study.