Rationale:
The 2HELPS2B score is a validated clinical tool that is used to aid in seizure detection and to stratify risk of seizures in critically ill patients undergoing electroencephalogram (EEG) monitoring. Its conception was designed around the implementation of a simple scoring system to enhanced communication and patient care to aid in clinical judgement. [1] While this tool has been validated in subsequent studies to stratify seizure risk prevention for critically ill patients, its clinically utility in the epilepsy monitoring unit (EMU) has yet to be investigated. [2] This study intends to investigate retrospective implementation of a 2HELPS2B score based on the initial of report of video EEG monitoring for patients admitted to the epilepsy monitoring unit.
Methods:
All patients who were admitted to the epilepsy monitoring unit from January 2023 through December 2024 underwent chart review of reports. The inclusion criteria were adults > 18 years who were admitted for spell characterization, presurgical evaluation, ictal SPECT using scalp EEG monitoring. Patients with seizures captured or non-diagnostic studies (with abnormal interictal findings) were included in data analysis. Confirmed non-epileptic events and non-diagnostic studies with normal interictal EEG were excluded. The 2HELPS2B score was calculated based on the initial reports of each patient (consisting of ~12-14 hours of data). Outcome measures of time to first seizure (TTFS, hours), length of stay (LOS, days), and number of seizures captured were analyzed.
Results:
Of the 518 patients admitted to the epilepsy monitoring unit, 218 patients met inclusion criteria with seizures captured on EEG. 59 (27%) patients had a 2HELPS2B score of 1, 115 (53%) with a score of 2, 30 (14%) with a score of 3, 10 (5%) with a score of 4, and 4 (2%) with a score of 5. A Kruskal-willis was used to compare median time to first seizure, number of seizures captured, and length of stay across calculated 2HELPS2B scores. Pairwise comparisons were then analyzed to find a statistically significant difference between number of seizures captured for 2HELPS2B score 1 versus 4 (3 seizures vs. 9.5 seizures, P < .001). There were observed trends among outcomes of TTFS and number of seizures, with increasing number of seizures captured with increased 2HELPS2B score and decreased TTFS with increased 2HELPS2B score. There were no other statistically significant relationships identified.