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Development of a novel outcome prediction score (PEDSS) for pediatric convulsive status epilepticus: A longitudinal
Richa Tiwari1, Biswaroop Chakrabarty1, Sheffali Gulati1
1Center of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
A new score, PEDSS, accurately predicts outcomes for pediatric convulsive status epilepticus (CSE). This score aids in assessing mortality and recovery at the hospital and 3 months postdischarge.
Area of Science:
- Neurology
- Pediatric Medicine
- Critical Care
Background:
- Pediatric convulsive status epilepticus (CSE) is a medical emergency with variable outcomes.
- Accurate prediction of in-hospital and long-term outcomes is crucial for patient management.
- Existing scores like ENDIT may have limitations in predicting CSE outcomes.
Purpose of the Study:
- To evaluate the predictive performance of the ENDIT score for pediatric CSE.
- To develop and validate a novel score for predicting in-hospital and 3-month postdischarge outcomes in pediatric CSE.
Main Methods:
- A cohort of 61 children and adolescents (1 month to 14 years) with CSE was studied.
- In-hospital and 3-month postdischarge outcomes were assessed using the Pediatric Cerebral Performance Category Scale (PCPCS).
- The ENDIT score was evaluated, and a new score, PEDSS (Pediatric Status Epilepticus Score), was developed based on significant predictors.
Main Results:
- The ENDIT score showed moderate predictive accuracy (AUC 0.7-0.74) for mortality and outcomes.
- The novel PEDSS score demonstrated high predictive accuracy (AUC 0.8-0.93) for mortality and outcomes.
- Optimal PEDSS cutoffs were identified for predicting mortality (≥4) and poor outcomes (≥3) at both time points.
Conclusions:
- The PEDSS score is a highly accurate tool for predicting mortality and outcomes in pediatric CSE.
- PEDSS can assist clinicians in managing pediatric CSE patients and anticipating postdischarge status.
- Further validation of PEDSS in diverse settings and in adult populations is recommended.
Objective:
The objectives of this study were to evaluate ENDIT score and develop a novel outcome prediction score for outcome of pediatric convulsive status epilepticus (CSE) at the hospital and 3 months postdischarge.
Methods:
Children and adolescents aged 1 month to 14 years, presenting with CSE to a tertiary care teaching center in North India from January 2017 to March 2019, were screened for enrollment. In-hospital and 3-month postdischarge outcome were defined as poor if Pediatric Cerebral Performance Category Scale (PCPCS) score dropped by ≥2 levels.
Results:
Overall, 61 patients were enrolled for final analysis after applying exclusion and inclusion criteria. The area under the receiver operating characteristic (ROC) curve for ENDIT score in predicting mortality and differentiating good from poor outcome at the hospital and at 3 months postdischarge was 0.74 (95% confidence interval [CI] = 0.58-0.89), 0.7 (95% CI = 0.57-0.83), and 0.72 (95% CI = 0.6-0.82), respectively. Based on predictors in the present cohort that were significantly different between good and poor outcome cases at the hospital and 3 months postdischarge, a new six-point score named PEDSS (pre-status epilepticus PCPCS, background electroencephalographic abnormalities, drug refractoriness, semiology, and critical sickness) was developed. The area under ROC curves for PEDSS score in predicting mortality and differentiating good from poor outcome at the hospital and at 3 months postdischarge were 0.93 (95% CI = 0.87-0.99), 0.8 (95% CI = 0.7-0.9), and 0.89 (95% CI = 0.8-0.96), respectively. The best cutoff PEDSS scores for predicting mortality and poor outcome at the hospital and at 3 months postdischarge were ≥4, ≥3, and ≥3, respectively.
Significance:
The PEDSS score has high predictive accuracy for mortality and differentiating good from poor outcome at the hospital and 3 months postdischarge in pediatric CSE. Future studies should be planned to validate it in various geographical and health care settings and in adults.
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