Prognostic performance of STESS and qSOFA scores in pre-hospital status epilepticus: A prospective cohort study

Status epilepticus (SE) is a life-threatening, multisystem disorder. Prognostic factors are variable, and several scores have been developed for SE, some requiring electroencephalogram results that may not be available pre-hospital. We aimed to evaluate the prognostic performance of two rapid, easily applicable pre-hospital scores: the STESS and qSOFA scores.

We conducted a prospective, observational study of SE patients managed in pre-hospital emergency care in Tunis over 35 months. We assessed the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and optimal cutoffs for both STESS and qSOFA in predicting 48-hour mortality, in-hospital mortality, and the need for mechanical ventilation.

One hundred SE patients with motor-predominant seizures were included. For 48-hour mortality, AUC was 0.855 for STESS and 0.787 for qSOFA; for mechanical ventilation, AUC was 0.693 and 0.705, respectively. STESS ≥3 predicted 48-hour mortality with specificity 87.0% and sensitivity 66.7%, while qSOFA ≥3 had specificity 95.8% and sensitivity 64.3%. Exploratory analysis for in-hospital mortality (37%) showed STESS ≥3 with specificity 86% and sensitivity 68%, and qSOFA ≥3 with specificity 95% and sensitivity 64%.

STESS and qSOFA are simple, rapid scores suitable for pre-hospital SE management. Both exhibit good specificity but moderate sensitivity. STESS may be more informative for in-hospital outcomes, while qSOFA reflects early systemic severity. Scores should be interpreted alongside a comprehensive clinical assessment to guide triage and early management.