TY - JOUR
T1 - Untangling operational failures of the Status Epilepticus Severity Score (STESS)
AU - Sutter, Raoul
AU - Semmlack, Saskia
AU - Opić, Petra
AU - Spiegel, Rainer
AU - De Marchis, Gian Marco
AU - Hunziker, Sabina
AU - Kaplan, Peter W.
AU - Rüegg, Stephan
AU - Marsch, Stephan
N1 - Funding Information:
R. Sutter received research grants from the Swiss National Foundation (No 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Bangerter-Rhyner Foundation. He received personal grants from UCB-pharma and holds stocks from Novartis Roche, and Johnson & Johnson. S. Semmlack, P. Opić, and R. Spiegel report no disclosures relevant to the manuscript. G.M. De Marchis was or is supported by the Swiss National Science Foundation, Science Funds of the University Hospital
Funding Information:
Basel and University of Basel, Bangerter-Rhyner-Foundation, Swisslife Jubiläumsstiftung for Medical Research, Swiss Neurologic Society, Fondazione Dr. Ettore Balli, De Quervain research grant, and Thermo Fisher GmbH; and received travel honoraria from Bayer and speaker honoraria from Medtronic and BMS/Pfizer. S. Hunziker reports no disclosures relevant to the manuscript. P. Kaplan has provided unsponsored grand rounds; published books on EEG, status epilepticus, and epilepsy, for which he received honoraria; has consulted for Cadwell; and has been on the board of the ABCN, ICCN, and the ACNS. S. Rüegg received unconditional research grants from UCB-pharma; honoraria from serving on the scientific advisory boards of Desitin, Eisai, GSK, and UCB-pharma; travel grants from GSK, Janssen-Cilag, and UCB-pharma; speaker fees from UCB-pharma and from serving as a consultant for Eisai, GlaxoSmithKline, Janssen-Cilag, Pfizer, Novartis, and UCB-pharma; does not hold any stocks of any pharmaceutical industries or manufacturers of medical devices; received funding from UCB-pharma, Novartis, and Swiss National Science Foundation Grants: grant number 320030_169379/1 and coapplicant for grants numbers 33CM30_125115/1 and 33CM30_140338/1; and is the president of the Swiss League against Epilepsy (no payments), Editor of Epileptologie (Journal of the Swiss League against Epilepsy) (no payments), and Editor of the Swiss EEG Bulletin (payments from UCB). S. Marsch reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Publisher Copyright:
© 2019 American Academy of Neurology.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/4/23
Y1 - 2019/4/23
N2 - ObjectiveTo uncover clinical characteristics leading to false outcome prediction of the Status Epilepticus Severity Score (STESS), a validated and broadly used clinical scoring system for outcome prediction in status epilepticus (SE).MethodsFrom 2005 to 2016, adult patients with SE treated at the University Hospital Basel, Switzerland, were included. To assess independent associations of variables differing between patients with false and correct prediction of death (STESS ≥ 3), multivariable logistic regression models were computed using automated selection.ResultsAmong 467 patients, 12% died. The median STESS was 3 (interquartile range 2-4). Regarding prediction of death, the STESS was false-positive in 51% and false-negative in 1%. Patients surviving despite having a STESS ≥3 had less fatal etiologies, less nonconvulsive SE with coma, and lower Charlson Comorbidity Index, Simplified Acute Physiology Score II, and Acute Physiology and Chronic Health Evaluation II scores. In multivariable analyses, odds for survival were high with SE types other than nonconvulsive status with coma and low with an increasing Charlson Comorbidity Index in patients with a STESS ≥ 3 (odds ratio [OR]for survival 4.23, 95% confidence interval [CI] 2.33-9.60; and ORfor survival 0.86, 95% CI 0.75-0.98). In patients with SE types other than nonconvulsive with coma, the STESS was mainly increased because they were frequently older than 65 years and had no seizure history.ConclusionsThe STESS frequently and inadequately predicts death especially in patients with SE other than nonconvulsive with coma and few comorbidities. Clinicians are urged to interpret a STESS ≥3 with caution in such patients.
AB - ObjectiveTo uncover clinical characteristics leading to false outcome prediction of the Status Epilepticus Severity Score (STESS), a validated and broadly used clinical scoring system for outcome prediction in status epilepticus (SE).MethodsFrom 2005 to 2016, adult patients with SE treated at the University Hospital Basel, Switzerland, were included. To assess independent associations of variables differing between patients with false and correct prediction of death (STESS ≥ 3), multivariable logistic regression models were computed using automated selection.ResultsAmong 467 patients, 12% died. The median STESS was 3 (interquartile range 2-4). Regarding prediction of death, the STESS was false-positive in 51% and false-negative in 1%. Patients surviving despite having a STESS ≥3 had less fatal etiologies, less nonconvulsive SE with coma, and lower Charlson Comorbidity Index, Simplified Acute Physiology Score II, and Acute Physiology and Chronic Health Evaluation II scores. In multivariable analyses, odds for survival were high with SE types other than nonconvulsive status with coma and low with an increasing Charlson Comorbidity Index in patients with a STESS ≥ 3 (odds ratio [OR]for survival 4.23, 95% confidence interval [CI] 2.33-9.60; and ORfor survival 0.86, 95% CI 0.75-0.98). In patients with SE types other than nonconvulsive with coma, the STESS was mainly increased because they were frequently older than 65 years and had no seizure history.ConclusionsThe STESS frequently and inadequately predicts death especially in patients with SE other than nonconvulsive with coma and few comorbidities. Clinicians are urged to interpret a STESS ≥3 with caution in such patients.
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U2 - 10.1212/WNL.0000000000007365
DO - 10.1212/WNL.0000000000007365
M3 - Article
C2 - 30918093
AN - SCOPUS:85065114021
SN - 0028-3878
VL - 92
SP - E1948-E1956
JO - Neurology
JF - Neurology
IS - 17
ER -