Status Epilepticus in Pediatric patients Severity Score (STEPSS): A clinical score to predict the outcome of status epilepticus in children- a prospective cohort study

Purpose: In adults, the Status Epilepticus Severity Score (STESS), a clinical score, has been shown to be a good predictor of outcome and treatment response. We devised a pediatric modification of this score: the Status Epilepticus in Pediatric patients Severity Score (STEPSS) and evaluated it in children with status epilepticus. Methods: In this prospective study, children aged 1 month to 18 years presenting with seizure duration >= 5 min or actively convulsing to the emergency room were enrolled. STEPSS score was calculated at the time of admission. Outcomes included death, the Pediatric Overall Performance Category (POPC) at discharge and treatment response. The diagnostic utility of the STEPSS score to predict unfavourable outcome was evaluated. Results: One-hundred and forty children (mean age 5.8 years) were enrolled. Seven children died and overall 15 children had an unfavourable outcome. The predictive accuracy of STEPSS at a cut-off of > 3: for unfavourable outcome (POPC score >= 3) - sensitivity (0.93 [95% CI: 68, 99.8]), specificity (0.81 [95% CI: 0.73, 0.87]), PPV (0.37 [95% CI: 0.22, 0.54]), NPV (0.99 [95% CI: 0.95-1.0]), positive likelihood ratio (4.86), Fl score (0.530); for death - sensitivity (0.86 [95% CI: 0.42, 0.99]), specificity (0.76 [95% CI: 0.68-0.83]), PPV (0.16 [95% CI: 0.06, 0.31]), NPV (0.99 [95% CI: 0.95, 1.0]), Fl score (0.270). Conclusions: The STEPSS, a simple bedside clinical score, was found to be useful to predict the outcome and treatment response in children with status epilepticus.