title: Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores.
abstract: BACKGROUND
  Two clinical scoring systems, the status epilepticus severity score (STESS) and the epidemiology-based mortality score in status epilepticus (EMSE), are used to predict mortality in patients with status epilepticus (SE). The aim of this study was to compare the outcome-prediction function of the two scoring systems regarding in-hospital mortality using a multicenter large cohort of adult patients with SE. Moreover, we studied the potential role of these two scoring systems in predicting the functional outcome in patients with SE.
  
  
  METHODS
  The SE cohort consisted of patients from the epilepsy centers of eight academic tertiary medical centers in South Korea. The clinical and electroencephalography data for all adult patients with SE from January 2013 to December 2014 were derived from a prospective SE database. The primary outcome variable was defined as in-hospital death. The secondary outcome variable was defined as a poor functional outcome, i.e., a score of 1-3 on the Glasgow Outcome Scale, at discharge.
  
  
  RESULTS
  Among the 120 non-hypoxic patients with SE recruited into the study, 16 (13.3%) died in the hospital and 64 (53.3%) were discharged with a poor functional outcome. The receiver-operating characteristic (ROC) curve for prediction of in-hospital death based on the STESS had an area under the curve of 0.673 with an optimal cutoff value for discrimination (best match for both sensitivity (0.56) and specificity (0.70)) that was ≥ 4 points. The two combinations of elements of the EMSE system (EMSE-ALDEg and EMSE-ECLEg) predicted not only in-hospital mortality with the best match for sensitivity (more than 0.6) and specificity (more than 0.6), but also a poor functional outcome with the best match for both sensitivity (>0.7) and specificity (>0.6). STESS did not predict a poor functional outcome (area under the ROC, 0.581; P = 0.23).
  
  
  CONCLUSIONS
  Although the EMSE is a clinical scoring system that focuses on individual mortality, we did not find differences between the EMSE and STESS in the prediction of in-hospital death. The EMSE was useful in predicting poor functional outcome, as it was significantly better than STESS.
authors.affiliation: Department of Neurology, Korea University Anam Hospital, Seoul, South Korea. sookb99@gmail.com.
authors.forename: Bong Su
authors.initials: BS
authors.lastname: Kang
authors.affiliation: Department of Neurology, Konkuk University School of Meidcine, Seoul, South Korea. drdongwkim@gmail.com.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea. neukim@gmail.com.
authors.forename: Kwang Ki
authors.initials: KK
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea. moonhyejin21@gmail.com.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Moon
authors.affiliation: Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea. youngsookim0127@gmail.com.
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Neurology, National Medical Center, Seoul, South Korea. crespin97@gmail.com.
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Neurology, Kangwon National University School of Medicine, Chuncheon, South Korea. raininaugust@hanmail.net.
authors.forename: Seo-Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Neurology, Korea University Anam Hospital, Seoul, South Korea. yo904@naver.com.
authors.forename: Yong Seo
authors.initials: YS
authors.lastname: Koo
authors.affiliation: Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. limitsum@gmail.com.
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Shin
authors.affiliation: Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea. jangsup.moon@gmail.com.
authors.forename: Jangsup
authors.initials: J
authors.lastname: Moon
authors.affiliation: Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea. ultrajs4@gmail.com.
authors.forename: Jun-Sang
authors.initials: JS
authors.lastname: Sunwoo
authors.affiliation: Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea. mr830611@gmail.com.
authors.forename: Jung-Ick
authors.initials: JI
authors.lastname: Byun
authors.affiliation: Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea. neurocho@gmail.com.
authors.forename: Yong Won
authors.initials: YW
authors.lastname: Cho
authors.affiliation: Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea. jungky10@gmail.com.
authors.forename: Ki-Young
authors.initials: KY
authors.lastname: Jung
authors.affiliation: Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea. stemcell.snu@gmail.com.
authors.forename: Kon
authors.initials: K
authors.lastname: Chu
authors.affiliation: Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea. sangkun2923@gmail.com.
authors.forename: Sang Kun
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D013226:Status Epilepticus / Q000401:mortality*
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