AI Article Synopsis
- Objective: The study evaluated the effectiveness of three prognostic scores (STESS, EMSE-EACE, and END-IT) in forecasting outcomes for patients experiencing status epilepticus (SE) in the neurology ICU, focusing on mortality and functional decline.
- Methods: Researchers reviewed data from neurology ICU patients with SE who required continuous EEG monitoring over ten years and applied the prognostic scores, analyzing their ability to predict outcomes using ROC analysis.
- Results: Out of 85 patients, 36.5% experienced inpatient mortality and 78.8% had functional decline, with STESS and EMSE-EACE demonstrating acceptable predictive value for mortality, while all three scores performed poorly in predicting functional outcomes at discharge.
Article Abstract
Objective: Status epilepticus (SE) in the neurology intensive care unit (ICU) is associated with significant morbidity. We aimed to evaluate the utility of existing prognostic scores, namely the Status Epilepticus Severity Score (STESS), Epidemiology Based Mortality Score in Status Epilepticus (EMSE)-EACE and Encephalitis-Nonconvulsive Status Epilepticus-Diazepam Resistance-Image Abnormalities-Tracheal Intubation (END-IT), among SE patients in the neurology ICU.
Methods: Neurology ICU patients with SE requiring continuous electroencephalography (cEEG) monitoring over a 10 year period were included. The STESS, EMSE-EACE and END-IT scores were applied retrospectively. Receiver operating characteristic (ROC) analysis was performed to assess the discriminatory value of the scores for inpatient mortality and functional decline, as measured by increase in the modified Rankin Scale (mRS) on discharge.
Results: Eighty-five patients were included in the study, of which 71 (83.5%) had refractory SE. Inpatient mortality was 36.5%. Sixty - seven (78.8%) of patients suffered functional decline, with a median mRS of 5 upon hospital discharge. The AUCs of the STESS, EMSE-EACE and END-IT scores associated with inpatient mortality were 0.723 (95% CI 0.613-0.833), 0.722 (95% CI 0.609-0.834) and 0.560 (95% CI 0.436-0.684) respectively. The AUCs of the STESS, EMSE-EACE and END-IT scores associated with functional decline were 0.604 (95% CI 0.468-0.741), 0.596 (95% CI 0.439-0.754) and 0.477 (95% CI 0.331-0.623).
Significance: SE was associated with high mortality and morbidity in this cohort of neurology ICU patients requiring cEEG monitoring. The STESS and EMSE-EACE scores had acceptable AUCs for prediction of inpatient mortality. However, the STESS, EMSE-EACE and END-IT were poorly-correlated with discharge functional outcomes. Further refinements of the scores may be necessary among neurology ICU patients for predicting discharge functional outcomes.
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| http://dx.doi.org/10.1016/j.jns.2024.122953 | DOI Listing |
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