The ADAN Scale: A Proposed Scale for Prehospital Use to Identify Status Epilepticus
Abstract number :
2.114
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2018
Submission ID :
501436
Source :
www.aesnet.org
Presentation date :
12/2/2018 4:04:48 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Estevo Santamarina, Hospital Universitario Vall d’Hebron; Manuel Requena, Hospital Vall Hebron; Elena Fonseca, Hospital Vall Hebron; Marta Olive, Hospital Vall Hebron; Laura Abraira, Vall d'Hebron Hospital; Manuel Quintana, Vall d´Hebron Hospit
Rationale: The prognosis of status epilepticus (SE) depends largely on the time between the onset and the diagnosis and start of treatment. Our aim was to design a simple scale with predictive value for prehospital diagnosis of SE. Methods: Retrospective study of 292 consecutive patients attended in our hospital emergency department for an epileptic seizure in 2014-2015. Forty-nine patients fulfilled the clinical/encephalographic criteria for SE. We recorded the patients’ history of epilepsy, predisposing lesion, and clinical features: aphasia, eye deviation, hemiparesis, sphincter incontinence, tongue bite, level of consciousness, and number of seizures. Variables independently associated with SE were combined to design a clinical scale. The performance of the scale was evaluated in a validation dataset of 197 patients (attended in 2016). Results: In 2014-2015, 50.3% were men and the mean age was 55.9 years. In patients with SE, 51% were men and the mean age, 65.7 years. The following features were more prevalent in SE patients than the remaining patients: aphasia (79.6% vs 18.9%, p2 seizures (Number of seizures). We evaluated ADANscale in all 197 patients attended in 2016; demographics were similar to the sample used to define the scale. In this population, a total of 43 had final diagnosis of SE. When comparing the validation sample with the population used in the validation, we observed a higher rate of seizures (60.4% vs. 52.2%), hemiparesis (21.3% vs. 13.1%), incontinence (24.9% vs. 11.3%) and number of crisis, with a lower rate of oculocephalic deviation (10.7% vs 23.5%). The predictive capacity of the scale for identifying SE in the validation dataset was 98.7% (95%CI: 97.3%-100%); a score>1 predicted the presence of SE with a PPV of 85.4% and a PNV of 98.7%. Conclusions: A score >1 on the ADAN scale is a robust predictor of the diagnosis of SE in patients who experience an out-of-hospital epileptic seizure. This simple scale may be a useful tool for clinical use and warrants further investigation. Funding: No funding received.