@article{773f0d27320f49ab98a277be7d3fdef2,
title = "Illness severity scoring in status epilepticus—When STESS meets APACHE II, SAPS II, and SOFA",
abstract = "Objective: To characterize a critically ill cohort with status epilepticus (SE) by the illness severity scoring systems SAPS II (Simplified Acute Physiology Score II), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SOFA (Sequential Organ Failure Assessment), and to compare their performance with the STESS (Status Epilepticus Severity Score) for outcome prediction. Methods: The prospective cohort study was carried out at the University Hospital Basel, a Swiss tertiary academic medical care center. Consecutive adult SE patients hospitalized in the intensive care units from 2011 to 2016 were included. Illness severity scores and additional clinical data were recorded. Logistic regression models using automated variable selection were applied to identify scores associated with no return to functional and neurological baseline and death. Measures of discrimination and calibration were assessed. Results: Among 184 patients, 33% returned to baseline. Median scores of the illness severity scores were within the lowest third of the possible scoring ranges, and all differed significantly between patients with and without return to baseline. The areas under the receiver operating curves for the prediction of no return to baseline and death ranged from 0.64 to 0.73, with the highest value for the STESS predicting no return to baseline. Measures of calibration revealed adequate model fit for all analyses. Among integral components of the scoring systems, only the Glasgow Coma Scale (GCS) differed significantly between patients with and without return to baseline. In multivariable analyses, decreasing GCS and increasing STESS had the strongest associations (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.77-0.93 and OR = 1.34, 95% CI = 1.05-1.68, respectively) with no return to baseline independent of all other scoring systems, whereas the APACHE II revealed the strongest association with death (OR = 1.15, 95% CI = 1.06-1.25). Significance: Although complex illness severity scoring systems in SE patients facilitate benchmarking and comparisons with other severely ill patient cohorts, they offer no advantages over the STESS and GCS regarding prediction of no return to baseline.",
keywords = "neurocritical care, outcome prediction, scoring systems, status epilepticus",
author = "Saskia Semmlack and Kaplan, {Peter W.} and Rainer Spiegel and {De Marchis}, {Gian Marco} and Sabina Hunziker and Kai Tisljar and Stephan R{\"u}egg and Stephan Marsch and Raoul Sutter",
note = "Funding Information: P.W.K. has provided unsponsored grand rounds and has published books on EEG, status epilepticus, and epilepsy for which he received honoraria, and has received the Qatar Research Foundation grant for continuous EEG monitoring in status epilepticus. G.M.D.M. has been supported by the Swiss National Science Foundation, Science Funds of the University Hospital Basel and University of Basel, the Bangerter‐Rhyner Foundation, the Swisslife Jubil{\"a}umsstiftung for Medical Research, the Swiss Neurological Society, the Dr Ettore Balli Foundation, a De Quer-vain research grant, and Thermo Fisher; he has received travel honoraria from Bayer and speaker honoraria from Medtronic and BMS/Pfizer. S.R. has received funding from UCB, Novartis, and the Swiss National Science Foundation (grant 320030_169379/1 and as coapplicant for grants 33CM30_125115/1 and 33CM30_140338/1); he is the President of the Swiss League against Epilepsy (no payments), Editor of Epileptologie (the journal of the Swiss League Against Epilepsy; no payments), and Editor of the Swiss EEG Bulletin (payments from UCB); he has received honoraria for serving on the scientific advisory boards of Desitin, Eisai, GlaxoSmithKline (GSK), and UCB Pharma, travel grants from GSK, Janssen‐Cilag, and UCB Pharma, speaker fees from UCB Pharma, and honoraria for serving as a consultant for Eisai, GSK, Janssen‐Cilag, Pfizer, Novartis, and UCB Pharma; he does not hold any stocks of any pharmaceutical industries or manufacturers of medical devices. R.Su. has received research grants from the Swiss National Foundation (grant 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Bangerter‐Rhyner Foundation; he has received personal grants from UCB Pharma and holds stock in Novartis and Roche. The other authors have no conflicts of interest to report. We confirm that we have read the Journal{\textquoteright}s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Publisher Copyright: Wiley Periodicals, Inc. {\textcopyright} 2018 International League Against Epilepsy",
year = "2019",
month = feb,
doi = "10.1111/epi.14623",
language = "English (US)",
volume = "60",
pages = "189--200",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "2",
}