Abstract
Objective
Non convulsive status epilepticus (NCSE) is a frequent condition in the neurocritical care unit (NCCU) patient population with high morbidity and mortality. We aimed to assess the validity of available outcome prediction scores for prognostication in a NCCU patient population in relation to their admission reason (NCSE vs. non-NCSE related).
Methods
All 196 consecutive patients diagnosed with NCSE during the NCCU stay between 01.2010 and 12.2020 were included. Demographics, SAPS II, NCSE characteristics, in-hospital and 3 month outcome were extracted from the electronic charts. STESS, EMSE, and END-IT were evaluated as previously described. Univariable and multivariable analysis as well as comparison of sensitivity/specificity/positive and negative predictive values/accuracy were performed.
Results
30.1% died during the hospital stay and 63.5% of survivors did not achieve favorable outcome at 3 months after onset of NCSE. Patients admitted primarily due to NCSE had longer NCSE duration and were more likely intubated at diagnosis. ROC for SAPS II, EMSE, STESS when predicting mortality was between 0.683 and 0.762. ROC for SAPS II, EMSE, STESS, END-IT when predicting 3 month outcome was between 0.649 and 0.710. The accuracy predicting mortality/outcome was low both when considering proposed cut-offs and optimized cut-offs (estimated using the Youden’s Index) as well as when adjusting for admission reason.
Significance
The scores EMSE, STESS, and END-IT perform poorly when predicting outcome of patients with NCSE in a NCCU environment. They should be interpreted cautiously and only in conjunction with other clinical data in this particular patient group.
JUL