The ADAN Scale for the Detection of Patients with Risk of Status Epilepticus: A Multicentre Prospective Study
Abstract number :
2.107
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2022
Submission ID :
2204721
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Estevo Santamarina, MD, PhD – Hospital Vall Hebron; Juan Luis Restrepo-Vera, MD – Epilepsy Unit – Hospital Vall Hebron; Jacint Sala, MD – Epilepsy Unit – Hospital Bellvitge; Beatriz Parejo-Carbonell, MD – Epilepsy Unit – Hospital Clínico San Carlos; Jordi Ciurans, MD – Hospital Germans Trias i Pujol; Juan Luis Becerra, MD, PhD – Epilepsy Unit – Hospital Germans Trias i Pujol; Daniel Campos, MD – Epilepsy Unit – Hospital Vall Hebron; Manuel Quintana, statistician – Epilepsy Unit – Hospital Vall Hebron; Irene García-Morales, MD, PhD – Epilepsy Unit – Hospital Clínico San Carlos
Rationale: Status epilepticus (SE) is a severe disease complicated by high mortality and poor functional outcome in survivors. Its diagnosis and adequate management might be delayed due to acute mimics or prolonged time to electroencephalogram (EEG) examination. This study aims to prospectively validate the ADAN scale, recently proposed to identify patients with high-risk of developing SE.
Methods: An observational, prospective, multicentre study was conducted. All patients with suspected seizures were scored on the ADAN scale on arrival at the emergency department or in the pre-hospital setting over a period of 21 months. We also collected and analysed their clinical characteristics and final diagnosis based on semiology and EEG Salzburg criteria. The receiver operating characteristic (ROC) curve of the scale was analysed to assess its predictive value for the diagnosis of SE.
Results: A total of 527 patients were recruited: 205 (38.9%) met SE criteria. In multiple regression analysis, Abnormal speech (P < 0.001), ocular Deviation (P = 0.001), Automatisms (P = 0.001), and the Number of motor epileptic seizures (P < 0.001) were shown to be the only clinical variables independently associated with the final diagnosis of SE. The predictive capacity of the scale was 90.5% (95% confidence interval, 87.9%-93.1%) to identify SE as the final diagnosis. Based on the scores obtained, we were able to establish 3 risk groups according to the identified proportion of SE patients in each score group: low (ADAN 0-1: 9.1%), moderate (ADAN 2: 48.3%) and high (ADAN >2: 92%). A cut-off point of >1 produced the highest sensitivity of 87.8% and a specificity of 78%, with a positive predictive value of 71.7% and a negative predictive value of 90.9%.
Conclusions: The ADAN scale is a simple, prospectively validated clinical tool useful for the identification of patients at high risk of SE in order to prompt their diagnosis and treatment.
Funding: This project was funded by Instituto de Salud Carlos III (PI19/01575).
Clinical Epilepsy