Epidemiology-based Mortality Score in Status Epilepticus (EMSE) of Leitinger et al

 

Patient selection: status epilepticus

 

Parameters:

(1) etiology (E)

(2) duration in hours (D)

(3) comorbidity (C), which is based on Charlson comorbidity score

(4) age (A)

(5) EEG (Eg)

(6) level of consciousness or LOC (L)

 

Parameter	Finding	Points
etiology	CNS anomalies	2
	drug reduction, withdrawal, poor compliance	2
	multiple sclerosis	5
	remote cerebrovascular disease or brain injury	7
	hydrocephalus	8
	alcohol abuse	10
	drug overdose	11
	head trauma	12
	cryptogenic	12
	brain tumor	16
	sodium imbalance	17
	metabolic disorder	22
	acute cerebrovascular disease	25
	CNS infection, acute	33
	anoxia	65
duration	< 1 hour	3
	>= 1 hour	33
age in years	21 to 30	1
	31 to 40	2
	41 to 50	3
	51 to 60	5
	61 to 70	7
	71 to 80	8
	> 80	10
EEG	none of the below	0
	after status ictal discharge (ASID)	40
	lateralized periodic discharge (LPD)	40
	generalized periodic discharge (GPD)	40
	spontaneous burst suppression	60
level of consciousness	awake	0
	somnolent or confused	5
	stupor	14
	coma	23

 

where:

• It is unclear if patients < 21 years of age are scored as 0 points.

 

Comorbidity – items scored 10 points if present:

(1) myocardial infarction

(2) congestive heart failure

(3) peripheral vascular disease

(4) cerebrovascular disease

(5) dementia

(6) chronic pulmonary disease

(7) connective tissue disease

(8) ulcer disease

(9) mild liver disease

 

Comorbidity – items scored 20 points if present:

(1) hemiplegia

(2) moderate or severe renal disease

(3) diabetes with end-organ damage

(4) any tumor including leukemia or lymphoma

 

Comorbidity – items scored 30 points if present:

(1) moderate or severe liver disease

 

Comorbidity – items scored 60 points if present:

(1) metastatic solid tumor

 

total score =

= SUM(points for all 6 parameters)

 

The authors also evaluated various combinations of 3 or 4 of the parameters, such as etiology, age, comorbidity and EEG (EACEg).

 

Interpretation:

• minimum score for all 6 parameters: 6

• maximum score with all 6 parameters: 368