Dataset Information

Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.

ABSTRACT: Two clinical scoring systems, the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE), are used to predict mortality in patients with status epilepticus (SE). The aim of this study was to compare the outcome-prediction function of the two scoring systems regarding in-hospital mortality using a multicenter large cohort of adult patients with SE. Moreover, we studied the potential role of these two scoring systems in predicting the functional outcome in patients with SE.The SE cohort consisted of patients from the epilepsy centers of eight academic tertiary medical centers in South Korea. The clinical and electroencephalography data for all adult patients with SE from January 2013 to December 2014 were derived from a prospective SE database. The primary outcome variable was defined as in-hospital death. The secondary outcome variable was defined as a poor functional outcome, i.e., a score of 1-3 on the Glasgow Outcome Scale, at discharge.Among the 120 non-hypoxic patients with SE recruited into the study, 16 (13.3%) died in the hospital and 64 (53.3%) were discharged with a poor functional outcome. The receiver-operating characteristic (ROC) curve for prediction of in-hospital death based on the STESS had an area under the curve of 0.673 with an optimal cutoff value for discrimination (best match for both sensitivity (0.56) and specificity (0.70)) that was ? 4 points. The two combinations of elements of the EMSE system (EMSE-ALDEg and EMSE-ECLEg) predicted not only in-hospital mortality with the best match for sensitivity (more than 0.6) and specificity (more than 0.6), but also a poor functional outcome with the best match for both sensitivity (>0.7) and specificity (>0.6). STESS did not predict a poor functional outcome (area under the ROC, 0.581; P = 0.23).Although the EMSE is a clinical scoring system that focuses on individual mortality, we did not find differences between the EMSE and STESS in the prediction of in-hospital death. The EMSE was useful in predicting poor functional outcome, as it was significantly better than STESS.

SUBMITTER: Kang BS

PROVIDER: S-EPMC4728818 | biostudies-other | 2016

REPOSITORIES: biostudies-other

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Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.

Kang Bong Su BS Kim Dong Wook DW Kim Kwang Ki KK Moon Hye Jin HJ Kim Young-Soo YS Kim Hyun Kyung HK Lee Seo-Young SY Koo Yong Seo YS Shin Jung-Won JW Moon Jangsup J Sunwoo Jun-Sang JS Byun Jung-Ick JI Cho Yong Won YW Jung Ki-Young KY Chu Kon K Lee Sang Kun SK

Critical care (London, England) 20160127

<h4>Background</h4>Two clinical scoring systems, the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE), are used to predict mortality in patients with status epilepticus (SE). The aim of this study was to compare the outcome-prediction function of the two scoring systems regarding in-hospital mortality using a multicenter large cohort of adult patients with SE. Moreover, we studied the potential role of these two scoring systems in ...[more]

PMID: 26812954

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Project description:OBJECTIVE:Examine the association of duration of therapeutic coma (TC) with seizure recurrence, morbidity, and mortality in refractory status epilepticus (RSE). Define an optimal window for TC that provides sustained seizure control and minimizes complications. METHODS:Retrospective, observational cohort study involving patients who presented with RSE to the University of Alabama at Birmingham or the University of California at San Francisco from 2010 to 2016. Relationship of duration of TC with primary and secondary outcomes was evaluated using two-sample t tests, simple linear regression, and chi-square tests. Multivariable linear and logistic regression models were used to identify independent predictors. Predictive ability of TC for seizure recurrence was quantified using a receiver-operating characteristic curve. Youden index was used to determine an optimal cutoff value. RESULTS:Multivariable analysis of clinical and treatment characteristics of 182 patients who were treated predominantly with propofol as anesthetic agent showed that longer duration of the first trial of TC (27.2 vs 15.6 hours) was independently associated with a higher chance of seizure recurrence following the first weaning attempt (P = 0.038) but not with poor functional neurologic outcome upon discharge, in-hospital complications, or mortality. Furthermore, higher doses of anesthetic utilized during the first trial of TC were independently associated with fewer in-hospital complications (P = 0.003) and associated with a shorter duration of mechanical ventilation and total length of stay. Duration of TC was identified as an independent predictor of seizure recurrence with an optimal cutoff point at 35 hours. SIGNIFICANCE:This study suggests that a shorter duration yet deeper TC as treatment for RSE may be more effective and safer than the currently recommended TC duration of 24-48 hours. Prospective and randomized trials should be conducted to validate these assertions.

Project description:ObjectiveTo validate all diagnostic prediction models for ruling out pulmonary embolism that are easily applicable in primary care.DesignSystematic review followed by independent external validation study to assess transportability of retrieved models to primary care medicine.Setting300 general practices in the Netherlands.ParticipantsIndividual patient dataset of 598 patients with suspected acute pulmonary embolism in primary care.Main outcome measuresDiscriminative ability of all models retrieved by systematic literature search, assessed by calculation and comparison of C statistics. After stratification into groups with high and low probability of pulmonary embolism according to pre-specified model cut-offs combined with qualitative D-dimer test, sensitivity, specificity, efficiency (overall proportion of patients with low probability of pulmonary embolism), and failure rate (proportion of pulmonary embolism cases in group of patients with low probability) were calculated for all models.ResultsTen published prediction models for the diagnosis of pulmonary embolism were found. Five of these models could be validated in the primary care dataset: the original Wells, modified Wells, simplified Wells, revised Geneva, and simplified revised Geneva models. Discriminative ability was comparable for all models (range of C statistic 0.75-0.80). Sensitivity ranged from 88% (simplified revised Geneva) to 96% (simplified Wells) and specificity from 48% (revised Geneva) to 53% (simplified revised Geneva). Efficiency of all models was between 43% and 48%. Differences were observed between failure rates, especially between the simplified Wells and the simplified revised Geneva models (failure rates 1.2% (95% confidence interval 0.2% to 3.3%) and 3.1% (1.4% to 5.9%), respectively; absolute difference -1.98% (-3.33% to -0.74%)). Irrespective of the diagnostic prediction model used, three patients were incorrectly classified as having low probability of pulmonary embolism; pulmonary embolism was diagnosed only after referral to secondary care.ConclusionsFive diagnostic pulmonary embolism prediction models that are easily applicable in primary care were validated in this setting. Whereas efficiency was comparable for all rules, the Wells rules gave the best performance in terms of lower failure rates.

Project description:BackgroundClinical prediction rules (CPRs) should be externally validated by independent researchers. Although there are many cardiovascular CPRs, most have not been externally validated. It is not known why some CPRs are externally validated by independent researchers and others are not.MethodsWe analyzed cardiovascular risk CPRs included in a systematic review. Independent external validations were identified by forward citation searches of derivation studies. Time between the publication of a cardiovascular CPR and the first independent external validation was calculated. We assessed Kaplan-Meier estimates of the probability to have an independent external validation. Using univariable Cox regression, we explored whether characteristics of derivation (design, location, sample size, number of predictors, presentation format, validation in derivation), reporting (participants, predictors, outcomes, performance measure, information for risk calculation), and publication (journal impact factor) are associated with time to the first independent external validation.ResultsOf 125 cardiovascular risk CPRs, 29 had an independent external validation. The median follow-up was 118 months (95% CI, 99-130). The 25th percentile of event time was 122 months (95% CI, 91-299). Cardiovascular risk CPRs from the USA were 4.15 times (95% CI, 1.89-9.13) more likely to have an independent external validation. Increasing the sample size of derivation by ten times was associated with a 2.32-fold (95% CI, 1.37-3.91) increase in the probability of having an independent external validation. CPRs presented with an internal validation tend to get an independent external validation sooner (HR = 1.73, 95% CI, 0.77-3.93). CPRs reporting all the information necessary for calculating individual risk were 2.65 (95% CI, 1.01-6.96) times more likely to have an independent external validation. Publishing a cardiovascular risk CPR in a journal that has one unit higher impact factor was associated with a 6% (95% CI, 3-9) higher likelihood of an independent external validation.ConclusionsThe probability for cardiovascular risk CPRs to get an independent external validation was low even many years after their derivations. Authors of new cardiovascular risk CPRs should consider using adequate sample size, conducting an internal validation, and reporting all the information needed for risk calculation as these features were associated with an independent external validation.

Dataset Information

Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.

Publications

Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.

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