More Accurate Prediction of Premorbid Recovery in Status Epilepticus With STESS, GCS

Investigators examined various scoring systems to predict recovery to premorbid neurological and functional status in critically ill patients with status epilepticus.

The Status Epilepticus Severity Score (STESS) and Glasgow Coma Scale (GCS) offer the best method for predicting recovery to premorbid neurologic and functional status in critically ill patients with status epilepticus (SE), particularly compared with the Simplified Acute Physiology Score II (SAPS II), the Acute Physiology and Chronic Health Evaluation II (APACHE II), and the Sequential Organ Failure Assessment (SOFA), according to study results published in Epilepsia.

Consecutive patients with SE who were hospitalized in intensive care units at a tertiary academic medical center (n=184) were enrolled in the study. The investigators recorded several illness severity scores, including the SAPS II, the APACHE II, and the SOFA. Return to baseline, or the clinical recovery after SE to the patient’s premorbid neurologic and functional status or no return to baseline, including death during hospital stay, comprised the primary outcome. Additional secondary outcomes included death during hospital stay, as well as within 30 days after the onset of SE.

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Approximately 33% of patients achieved the primary outcome by returning to baseline. Areas under the receiver operating curves for predicting no return to baseline and death for the patient were 0.70 and 0.72, 0.67 and 0.71, 0.64 and 0.66, and 0.73 and 0.67 for the SAPS II, APACHE II, SOFA, and STESS, respectively. These findings indicated that the STESS had the highest value for predicting no return to baseline.

The GCS was the only scoring system that differed between patients with and without return to baseline. Decreasing GCS and increasing STESS demonstrated the strongest associations (odds ratio [OR] 0.84; 95% CI, 0.77‐0.93 and OR 1.34; 95% CI, 1.05‐1.68, respectively). In addition, the APACHE II demonstrated the strongest association with mortality (OR 1.15; 95% CI, 1.06‐1.25).

Limitations of the study included its observational design, its recruitment of patients from a single center, and the lack of randomization or control.

“As the assessment of the STESS and GCS is much less labor intensive compared to the calculation of the SAPS II, APACHE II, and SOFA due to the smaller number and ready availability of the clinical integral components,” the researchers wrote, “future studies with SE patients in ICUs should be performed using the STESS and GCS.”


Semmlack S, Kaplan PW, Spiegel R, et al. Illness severity scoring in status epilepticus-When STESS meets APACHE II, SAPS II, and SOFA. Epilepsia. 2019;60(2):189-200.