Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy.

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Serval ID
serval:BIB_D4B2057D394A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy.
Journal
Journal of neurology
Author(s)
Rossetti A.O., Logroscino G., Milligan T.A., Michaelides C., Ruffieux C., Bromfield E.B.
ISSN
0340-5354 (Print)
ISSN-L
0340-5354
Publication state
Published
Issued date
10/2008
Peer-reviewed
Oui
Volume
255
Number
10
Pages
1561-1566
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Status epilepticus (SE) treatment ranges from small benzodiazepine doses to coma induction. For some SE subgroups, it is unclear how the risk of an aggressive therapeutic approach balances with outcome improvement. We recently developed a prognostic score (Status Epilepticus Severity Score, STESS), relying on four outcome predictors (age, history of seizures, seizure type and extent of consciousness impairment), determined before treatment institution. Our aim was to assess whether the score might have a role in the treatment strategy choice.
This cohort study involved adult patients in three centers. For each patient, the STESS was calculated before primary outcome assessment: survival vs. death at discharge. Its ability to predict survival was estimated through the negative predictive value for mortality (NPV). Stratified odds ratios (OR) for mortality were calculated considering coma induction as exposure; strata were defined by the STESS level.
In the observed 154 patients, the STESS had an excellent negative predictive value (0.97). A favorable STESS was highly related to survival (P < 0.001), and to return to baseline clinical condition in survivors (P < 0.001). The combined Mantel-Haenszel OR for mortality in patients stratified after coma induction and their STESS was 1.5 (95 % CI: 0.59-3.83).
The STESS reliably identifies SE patients who will survive. Early aggressive treatment could not be routinely warranted in patients with a favorable STESS, who will almost certainly survive their SE episode. A randomized trial using this score would be needed to confirm this hypothesis.

Keywords
Age Factors, Aged, Analysis of Variance, Cohort Studies, Consciousness, Female, Humans, Logistic Models, Male, Middle Aged, Neurologic Examination, Neuropsychological Tests, Odds Ratio, Prognosis, Seizures, Severity of Illness Index, Status Epilepticus/diagnosis, Status Epilepticus/mortality
Pubmed
Web of science
Open Access
Yes
Create date
09/03/2009 13:08
Last modification date
01/10/2019 7:19
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