A clinical score to predict survival after SE

A simple clinical score consisting of four parameters assessed at presentation reliably identifies patients surviving after status epilepticus (SE), according to a recent study report.The score reflects four parameters assessed before treatment or any diagnostic procedure: history of seizures, age, seizure type, and consciousness impairment. Seizure history is used as a surrogate for etiology, as the history is more likely to be available at presentation. The study investigators formulated and assessed three possible score structures, varying the impact of age and consciousness impairment in each structure. They then retrospectively applied the models to 127 episodes of SE and identified the most accurate cut-off value that predicted survival for each of the score structures. Each structure was then analysed to determine which would provide the highest negative predictive value (i.e. proportion of patients with low-risk score not having a fatal outcome) with, at the same time, an acceptable accuracy (averaged specificity and sensitivity).The best score structure involved a score of 1 for stuporous or comatose state of consciousness (and 0 for alert or somnolent/confused), 1 for generalised convulsive seizures, 2 for nonconvulsive SE with coma (and 0 for simple partial or complex partial seizures), 2 for age 65 years and over (and 0 for under 65 years), and 1 for history of seizures (and 0 for no seizure history). Applying this score structure (with a cut-off of ≥ 3) to a prospective cohort of 34 consecutive adults patients with SE resulted in a sensitivity of 1.000, specificity of 0.643, negative predictive value of 1.000, and accuracy of 0.822. The investigators explain, "In other words, six of six subjects with fatal outcome and 18 of 28 surviving patients were correctly identified."The investigators say, "The assessment of each variable of the score is critical. While age, consciousness impairment, and clinical seizure type are straightforward, seizure history may sometimes appear difficult to obtain... In case of doubt, we suggest scoring conservatively, i.e., as if the patient would have a negative seizure history."...