Status epilepticus severity score (STESS): A useful tool to predict outcome of status epilepticus

• A prospective study emphasizing the importance of STESS in management of status epilepticus (SE).
• STESS can reliably predict the outcome of SE.
• STESS has a high negative predictive value with respect to poor outcome of SE.

ObjectiveThe treatment protocols for status epilepticus (SE) range from small doses of intravenous benzodiazepines to induction of coma. The pros and cons of more aggressive treatment regimen remain debatable. The importance of an index need not be overemphasized which can predict outcome of SE and guide the intensity of treatment. We tried to evaluate utility of one such index Status epilepticus severity score (STESS).Methods44 consecutive patients of SE were enrolled in the study. STESS results were compared with various outcome measures: (a) mortality, (b) final neurological outcome at discharge as defined by functional independence measure (FIM) (good outcome: FIM score 5–7; bad outcome: FIM score 1–4), (c) control of SE within 1 h of start of treatment and (d) need for coma induction.ResultsA higher STESS score correlated significantly with poor neurological outcome at discharge (p = 0.0001), need for coma induction (p = 0.0001) and lack of response to treatment within 1 h (p = 0.001). A STESS of <3 was found to have a negative predictive value of 96.9% for mortality, 96.7% for poor neurological outcome at discharge and 96.7% for need of coma induction, while a STESS of <2 had negative predictive value of 100% for mortality, coma induction and poor neurological outcome at discharge.ConclusionSTESS can reliably predict the outcome of status epilepticus. Further studies on STESS based treatment approach may help in designing better therapeutic regimens for SE.