Abstract Details

Title Prediction of Mortality After Convulsive Status Epilepticus: The Status Epilepticus M3A2S2H Score

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S36 - Epilepsy Basic Mechanisms, Status Epilepticus, and Mortality (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background Status epilepticus is a life-threatening condition that often occurs with, and may be triggered by, other serious cerebral and systemic injuries. In the United States alone, there are up to 150,000 cases of SE every year.

Objective This study aimed to investigate in-patient mortality and predictors of death associated with convulsive status epilepticus (CSE) in a large nationwide cohort and create a clinical score to predict a patient’s mortality risk.

Design/Methods Retrospective data from the National Inpatient Sample (NIS) database between 2007 and 2014 were analyzed, including 123,082 adults with CSE. Univariate logistic testing identified admission variables, neurological and medical complications associated with mortality. A simplified clinical prediction score, called M3A2S2H, was generated using variables that were frequent (>1%) and had a significant impact on mortality.

Results The overall hospital mortality rate was 3.5%. Univariate analysis revealed that older age, female gender, past medical history, and acute hospital conditions were related to mortality. After reclassification, a final multivariable model with 27 clinical variables was constructed, and the eight strongest predictors were included in the M3A2S2H score: hypoxic-ischemic encephalopathy (2 points); age >60 years, acute symptomatic CSE, invasive mechanical ventilation, sepsis, metastases, and chronic liver failure (all 1 point); and medication nonadherence (-1 point). The mortality rate among patients with ≤0, 1, 2, 3, 4, or ≥5 of these risk factors progressively increased from 0.2%, 2.1%, 7.8%, 20.3%, 31.9%, to 50.0% (P<0.0001). Additionally, a similar stepwise trend was observed regarding discharge to a facility versus home without services (P<0.0001).

Conclusions

This study demonstrates that mortality in CSE cases occurs in 3.5% of adult hospital admissions. Identification of specific acute and chronic conditions using the M3A2S2H score can help predict the risk of death or disability.

Authors/Disclosures
Ariel Sacknovitz, Medical Student PRESENTER	Mr. Sacknovitz has nothing to disclose.
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .
Ankita Jain, MS	Miss Jain has nothing to disclose.
Eris Spirollari, BA	Mr. Spirollari has nothing to disclose.
Bridget Nolan	No disclosure on file
Eric Feldstein	Eric Feldstein has nothing to disclose.
Anaz Uddin, MD	Dr. Uddin has nothing to disclose.
Rolla Nuoman, MD (BCHP Pediatric Neurology Specialty at Saw Mill River Road)	Dr. Nuoman has nothing to disclose.
Jon Rosenberg, MD	Dr. Rosenberg has nothing to disclose.
Andrew Bauerschmidt, MD (Westchester Medical Center Advanced Physician Services, PC)	Dr. Bauerschmidt has nothing to disclose.
Philip Overby, MD (Boston Children'S Health Physicians)	Dr. Overby has nothing to disclose.
Steven M. Wolf, MD (Pediatric Neurology Boston Children's He)	Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Assertio. Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for LivaNova. Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurilis. Dr. Wolf has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MOnteris . Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Marinus . The institution of Dr. Wolf has received research support from Neuropace. The institution of Dr. Wolf has received research support from Eisai. The institution of Dr. Wolf has received research support from Aguestive. The institution of Dr. Wolf has received research support from Neurilis . The institution of Dr. Wolf has received research support from UCB. The institution of Dr. Wolf has received research support from SKLife . The institution of Dr. Wolf has received research support from Longboard . The institution of Dr. Wolf has received research support from Takeda. The institution of Dr. Wolf has received research support from biohaven. The institution of Dr. Wolf has received research support from Assertio. Dr. Wolf has received intellectual property interests from a discovery or technology relating to health care. Dr. Wolf has received publishing royalties from a publication relating to health care.
Tracey A. Milligan, MD, FAAN	Dr. Milligan has nothing to disclose.
Manisha G. Holmes, MD (Westchester Medical Center)	Dr. Holmes has nothing to disclose.
Chirag Gandhi (Westchester Medical Center)	Chirag Gandhi has nothing to disclose.
Mill Etienne, MD, MPH, FAAN	Dr. Etienne has nothing to disclose.
Stephan A. Mayer	No disclosure on file

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