The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus

Abstract

The prognosis of status epilepticus (SE) depends on the time between onset and the diagnosis and start of treatment. Our aim was to design a scale with predictive value for pre-hospital diagnosis of SE. This was a retrospective study of 292 patients who attended the emergency department for an epileptic seizure. A total of 49 patients fulfilled the criteria for SE. We recorded the patients' history and clinical features. Variables independently associated with SE were combined to design a clinical scale. The performance of the scale was evaluated in a validation dataset of 197 patients. A total of 50.3% of the patients were male and the mean age was 55.9years. The following features were more prevalent in patients with SE: abnormal speech (79.6% vs. 18.9%, P<0.001), eye deviation (69.4% vs. 14.0%, P<0.001), automatism (22.4% vs. 6.3%, P<0.001), hemiparesis (24.5% vs. 10.9%, P=0.011), state of stupor/coma (46.9% vs. 4.2%, P<0.001) and number of pre-hospital seizures, i.e. two (34.7% vs. 4.5%, P<0.001) or more than two (51.0% vs. 0.4%, P<0.001). Based on these findings, we designed a scale that scored 1 point each for presence of abnormal speech, eye deviation, automatism and two seizures, and 2 points for more than two seizures. The predictive capacity of the scale for identifying SE in the validation dataset was 98.7% (95% confidence interval, 97.3%-100%) and 85.4% of patients with a score >1 had SE. A score >1 on the ADAN scale is a robust predictor of the diagnosis of SE in patients who experience an epileptic seizure. This scale may be a useful tool for clinical use and warrants further investigation.