Abstracts

Rationale: Status epilepticus (SE) is a critical neurological emergency characterized by substantial morbidity and mortality rates, as well as a complex clinical course and treatment process. There are clinical scales used to predict mortality in SE, however, there is disagreement concerning the accuracy and usefulness of these current tools. The Acute Physiology and Chronic Health Evaluation (APACHE) II, designed for intensive care units, provides a general measure of disease severity. Currently, no prediction score exists for combining critical care assessment and current tools for mortality prediction in SE. This study aims to evaluate the predictive accuracy of the APACHE II score compared to the Status Epilepticus Severity Score (STESS) and newly modified Status Epilepticus Severity Score (nSTESS) in forecasting mortality associated with SE and to develop a novel predictor score suited to the critical care and disease-specific characteristics of SE.


Methods: A retrospective study included individuals with SE admitted to our medical center's intensive care unit between January 2016 and December 2023. The data collection was primarily based on electronic case review, encompassing the calculation and comparison of the APACHE II score, nSTESS and STESS. Based on the outcome of each case, the patients were divided into survivor and non-survivor groups. The predictive accuracy of APACHE II Score was then compared with that of the nSTESS and STESS. Through statistical analysis, significant discrepancies in disease-specific and critical care characteristics were identified, and a novel score (SPAA2) based on these three scales for predicting mortality of SE was developed.


Results: A total of 93 patients were initially identified, with 66 eventually included in the analysis. The mean age of the patients was 58.14 ± 16.2 years, and there was a higher prevalence of males (n=36, 54.5%). The in-hospital mortality rate was 21.2%, and generalized convulsive seizure was the most common seizure type (n=34, 51.5%). The APACHE II score, nSTESS, and SAPAA2 all revealed significant differences between survival and non-survival group (p = 0.000, p = 0.048, p = 0.000, respectively); however, the STESS showed no significant differences (p = 0.189). Receiver operating characteristic analysis revealed an area under the curve of 0.798 for the APACHE II score, 0.657 for the nSTESS, 0.563 for the STESS and 0.879 for the SPAA2.


Conclusions: Compared to the APACHE II score, nSTESS and STESS, the newly developed SPAA2 score demonstrates its potential as a reliable predictor of mortality in intensive care units for patients with SE. Further validation is necessary to confirm the reliability of the SPAA2 score.


Funding: National Science and Technology Council, Taiwan