Abstract
BackgroundPrediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge. The aim of this study was to characterize the prognostic factors and functional outcomes of patients after CSE in order to develop a practicable scoring system for outcome prediction.MethodsWe performed a retrospective explorative analysis on consecutive patients diagnosed with CSE between March, 2008 and November, 2014 in a tertiary academic medical center in northwest China. The modified Rankin Scale (mRS) was used to measure the functional outcome at three months post discharge.ResultsA total of 132 CSE patients was included, with a median age of 25.5 years and 60.6 % were male. Three months post discharge, an unfavorable outcome with mRS of 3–6 was seen in 62 (47.0 %) patients, 25 (18.9 %) of whom died. Logistic regression analysis revealed that encephalitis (p = 0.029), nonconvulsive SE (p = 0.018), diazepam resistance (p = 0.005), image abnormalities (unilateral lesions, p = 0.027; bilateral lesions or diffuse cerebral edema, p < 0.001) and tracheal intubation (p = 0.032) were significant independent predictors for unfavorable outcomes. Based on the coefficients in the model, these predictors were assigned a value of 1 point each, with the exception of the image, creating a 6-point scoring system, which we refer to as END-IT, for the outcome prediction of CSE. The area under the receiver operating characteristic curve for the END-IT score was 0.833 and using a cut-off point of 3 produced the highest sum sensitivity (83.9 %) and specificity (68.6 %). Compared with status epilepticus severity score (STESS) and Epidemiology-based Mortality score in SE (EMSE), END-IT score showed better discriminative power and predictive accuracy for the outcome prediction.ConclusionsWe developed an END-IT score with a strong discriminative power for predicting the functional outcome of CSE patients. External prospective validation in different cohorts is needed for END-IT score.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1221-9) contains supplementary material, which is available to authorized users.
Highlights
Prediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge
An unfavorable outcome was more likely if the patient had initially presented with a lower Glasgow Coma Scale (GCS) score during the time of admission, experienced diazepam resistance and had a longer SE duration, suffered from encephalitis and tracheal intubation, received more than three intravenous antiepileptic drug (AED) and had a drug induced coma, progressed to nonconvulsive SE (NCSE), and displayed abnormal brain images (p < 0.05). These variables were entered into the multivariate logistic regression model, and the results indicated that only encephalitis, NCSE, diazepam resistance, imaging abnormalities, and tracheal intubation were significant independent predictors for an unfavorable outcome (Table 3)
In order to establish a straightforward prognostic indicator to be used in clinical practice, we developed a scoring system comprised of the aforementioned five risk factors and named it END-IT, which is an acronym for encephalitis, NCSE, diazepam resistance, image abnormalities and tracheal intubation
Summary
Prediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge. Two scores for SE outcome prediction are available, the Status Epilepticus Severity Score (STESS) [5, 6] and the Epidemiology based Mortality score in SE (EMSE) [7]. The EMSE score was derived from a retrospective, exploratory analysis based on epidemiological data and taking into consideration etiology, age, comorbidity and electroencephalogram (EEG) data [7]. Both of these scores have been primarily used to predict survival vs death in the hospital setting. No scoring system currently exists for the purpose of predicting the functional outcome of patients with CSE once they have been discharged
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
