Status Epilepticus in Pediatric Patients Severity Score (STEPSS): A Clinical Score to Predict the Outcome of Status Epilepticus in Children

Purpose In adults, Status Epilepticus Severity Score (STESS) is a good predictor of clinical outcome and treatment response. We devised a pediatric modification of this score: 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 of at least 5 minutes or actively convulsing to the emergency were enrolled. The parameters noted for scoring STEPSS included: level of consciousness, age, type of seizure, and previous history of seizures. Outcomes included death, Pediatric Overall Performance Category (pOPC) at discharge, and treatment response. The primary outcome variable was the predictive accuracy of STEPSS score for determining unfavorable outcome (death or POPC ≥ 3; indicative of moderate disability or more).

Results: One hundred forty children (mean age = 5.8 years, 94 boys) were enrolled. Overall 15 children had an unfavorable outcome, while 7 died. At a cutoff of 3, STEPSS had 93.3% sensitivity, 80.8% specificity, and negative predictive value of 99% for unfavorable outcome. The negative predictive values for death and treatment failure (refractory or super-refractory status epilepticus) were 99% and 98%, respectively. At a cutoff of 2, STEPSS had 100% sensitivity, 60.6% specificity for unfavorable outcome, and 100% negative predictive value for unfavorable outcome, death, and treatment failure. The predictive accuracy was comparable to that of STESS in adults.

Conclusion: The STEPSS, a simple bedside clinical score was found to be useful to predict the outcome and treatment response in children with status epilepticus.