Guidelines for Neuroprognostication in Critically Ill Adults with Status Epilepticus.

Area of Science:

• Neurology
• Critical Care Medicine
• Clinical Neurophysiology

Background:

• Status epilepticus (SE) presents significant morbidity and mortality.
• Guidelines are needed for neuroprognostication in SE patients.
• Counseling surrogate decision-makers requires reliable outcome predictors.

Purpose of the Study:

• To provide broad principles of neuroprognostication in SE.
• To assess the reliability of clinical predictors for patient outcomes.
• To guide clinicians in counseling surrogates regarding SE prognosis.

Main Methods:

• A narrative systematic review using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
• Selection of candidate predictors based on clinical relevance and evidence availability.
• Evaluation of evidence quality, desirable/undesirable consequences, values, preferences, and resource use.

Main Results:

• Good practice recommendations include setting long-term goals and managing expectations for refractory SE.
• Nine clinical variables and two prediction models were evaluated.
• No selected variables or models reliably predicted mortality in SE patients.

Conclusions:

• This guideline offers principles for neuroprognostication in SE.
• It provides recommendations on the reliability of predictors for in-hospital mortality.
• Focus is on aiding clinicians in counseling surrogates for SE patients.