ArticleBMC neurology2025
Evaluation and comparison of mortality scores in status epilepticus patients.
Article in BMC neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveStatus epilepticus (SE) is a common neurological emergency associated with significant morbidity and mortality, with approximately one-third of patients demonstrating resistance to first-line treatment. Electroencephalography (EEG) plays a critical role not only in the diagnosis of SE but also in its monitoring and prognostication. This study aims to evaluate the performance of SE-specific severity scoring systems-Status Epilepticus Severity Score (STESS) and Epidemiology-Based Mortality Score in Status Epilepticus (EMSE)-in predicting mortality, in comparison with four widely used systemic severity scores: Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and the Inflammation, Nutrition, Consciousness, Neurologic function, and Systemic condition (INCNS) score. Furthermore, the effects on mortality of the Glasgow Coma Scale (GCS) for assessing level of consciousness, the age-adjusted Charlson Comorbidity Index (ACCI) for evaluating comorbidities, and the pre-SE Modified Rankin Scale (mRS) for measuring pre-existing morbidity will also be investigated.
methodsA total of 200 status epilepticus (SE) episodes in 188 patients with available EEG data, followed over a four-year period, were included in the study. The sensitivity, specificity, accuracy, and area under the curve (AUC) of each scoring system were calculated and compared.
resultsThe SOFA score demonstrated the highest performance in predicting mortality (AUC = 0.81). Systemic severity scores such as SAPS II, SOFA, APACHE II, and INCNS were found to be more effective in predicting mortality than the SE-specific scores STESS and EMSE.
conclusionThe evaluated scoring systems accounted for approximately 48% of mortality among adult SE patients; however, none were sufficient to predict mortality either alone or in combination. Therefore, there is a need for more specific prognostic scoring systems.
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