Prediction of Mortality After Convulsive Status Epilepticus: The Status Epilepticus M3A2S2H Score
Fawaz Al-Mufti1, Ariel Sacknovitz1, Ankita Jain1, Eris Spirollari1, Bridget Nolan4, Eric Feldstein1, Anaz Uddin4, Rolla Nuoman3, Jon Rosenberg3, Andrew Bauerschmidt5, Philip Overby6, Steven Wolf7, Tracey Milligan2, Manisha Holmes3, Chirag Gandhi3, Mill Etienne4, Stephan A. Mayer3
1Neurosurgery, 2Neurology, Westchester Medical Center, 3Westchester Medical Center, 4New York Medical College, 5Westchester Medical Center Advanced Physician Services, PC, 6Boston Children'S Health Physicians, 7Pediatric Neurology Boston Children's He
Objective:
This study aimed to investigate in-patient mortality and predictors of death associated with convulsive status epilepticus (CSE) in a large nationwide cohort and create a clinical score to predict a patient’s mortality risk.
Background:
Status epilepticus is a life-threatening condition that often occurs with, and may be triggered by, other serious cerebral and systemic injuries. In the United States alone, there are up to 150,000 cases of SE every year.
Design/Methods:
Retrospective data from the National Inpatient Sample (NIS) database between 2007 and 2014 were analyzed, including 123,082 adults with CSE. Univariate logistic testing identified admission variables, neurological and medical complications associated with mortality. A simplified clinical prediction score, called M3A2S2H, was generated using variables that were frequent (>1%) and had a significant impact on mortality.
Results:
The overall hospital mortality rate was 3.5%. Univariate analysis revealed that older age, female gender, past medical history, and acute hospital conditions were related to mortality. After reclassification, a final multivariable model with 27 clinical variables was constructed, and the eight strongest predictors were included in the M3A2S2H score: hypoxic-ischemic encephalopathy (2 points); age >60 years, acute symptomatic CSE, invasive mechanical ventilation, sepsis, metastases, and chronic liver failure (all 1 point); and medication nonadherence (-1 point). The mortality rate among patients with ≤0, 1, 2, 3, 4, or ≥5 of these risk factors progressively increased from 0.2%, 2.1%, 7.8%, 20.3%, 31.9%, to 50.0% (P<0.0001). Additionally, a similar stepwise trend was observed regarding discharge to a facility versus home without services (P<0.0001).
Conclusions:
This study demonstrates that mortality in CSE cases occurs in 3.5% of adult hospital admissions. Identification of specific acute and chronic conditions using the M3A2S2H score can help predict the risk of death or disability.
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