Prognostic scores in status epilepticus: A systematic review and meta‐analysis
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| Titel: | Prognostic scores in status epilepticus: A systematic review and meta‐analysis |
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| Autoren: | Fang Yuan, Charlotte Damien, Nicolas Gaspard |
| Quelle: | Epilepsia. 64:17-28 |
| Verlagsinformationen: | Wiley, 2022. |
| Publikationsjahr: | 2022 |
| Schlagwörter: | status epilepticus, review, Sciences bio-médicales et agricoles, Prognosis, Severity of Illness Index, Sensitivity and Specificity, 3. Good health, meta-analysis, 03 medical and health sciences, Status Epilepticus, 0302 clinical medicine, Status Epilepticus -- etiology, Predictive Value of Tests, Humans, in-hospital mortality, prognostic scores |
| Beschreibung: | The performance of prognostic scores of status epilepticus (SE) has been reported in very heterogeneous cohorts. We aimed to provide a summary of the available evidence on their respective performance. PubMed and EMBASE were searched for relevant articles. Studies were reviewed for eligibility for meta‐analysis of the area under the receiver‐operating characteristic curve (AUC) and for meta‐analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting in‐hospital mortality with scores in which at least two external evaluations had been published. This study was registered with PROSPERO (international prospective register of systematic reviews) (CRD42022325766). Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). In the meta‐analysis of AUC, 21 studies were pooled for STESS (Status Epilepticus Severity Score), five for EMSE‐EAC (Epidemiology‐based Mortality Score in Status Epilepticus ‐ Etiology, Age, level of Consciousness), five for EMSE‐EACE (EMSE ‐ Etiology, Age, level of Consciousness, EEG), and two for ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation). The pooled AUC of STESS, EMSE‐EAC, EMSE‐EACE, and ENDIT was 0.74 (95% CI: 0.71–0.78), 0.68 (95% CI 0.63–0.72), 0.77 (95% CI: 0.72–0.81), and 0.78 (95% CI: 0.70–0.87), respectively. The pooled sensitivity of STESS‐3, STESS‐4, EMSE‐EACE‐64, and ENDIT‐4 was 0.83 (95% CI: 0.80–0.86), 0.60 (95% CI: 0.55–0.65), 0.76 (95% CI: 0.67–0.83), and 0.70 (95% CI: 0.55–0.82), respectively. Their pooled specificity was 0.50 (95% CI: 0.48–0.52), 0.74 (95% CI: 0.72–0.76), 0.63 (95% CI: 0.59–0.67), and 0.65 (95% CI: 0.61–0.70), respectively. Their pooled PPV was 0.27 (95% CI: 0.24–0.30), 0.35 (95% CI: 0.29–0.41), 0.33 (95% CI: 0.24–0.43), and 0.20 (95% CI: 0.13–0.27). Their pooled NPV was 0.94 (95% CI: 0.93–0.96), 0.90 (95% CI: 0.89–0.92), 0.89 (95% CI: 0.80–0.98), and 0.95 (95% CI: 0.92–0.98). Variations in performance were observed in patients' subgroups, such as critically ill patients and refractory cases. Investigated scores only have acceptable AUC, sensitivity, and specificity for predicting in‐hospital mortality, with the EMSE‐EAC having a lower discriminative power. STESS‐3 has the highest sensitivity, and STESS‐4 the highest specificity, but neither combines acceptable sensitivity and specificity. All these scores had high NPV but very low PPV. Caution should be exercised in their clinical use. Further studies are required to develop more accurate scores. |
| Publikationsart: | Article |
| Dateibeschreibung: | 1 full-text file(s): application/pdf |
| Sprache: | English |
| ISSN: | 1528-1167 0013-9580 |
| DOI: | 10.1111/epi.17442 |
| Zugangs-URL: | https://pubmed.ncbi.nlm.nih.gov/36271624 |
| Rights: | Wiley Online Library User Agreement |
| Dokumentencode: | edsair.doi.dedup.....d17ee1e5bd3fa8e63bdde7346f2790be |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | The performance of prognostic scores of status epilepticus (SE) has been reported in very heterogeneous cohorts. We aimed to provide a summary of the available evidence on their respective performance. PubMed and EMBASE were searched for relevant articles. Studies were reviewed for eligibility for meta‐analysis of the area under the receiver‐operating characteristic curve (AUC) and for meta‐analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting in‐hospital mortality with scores in which at least two external evaluations had been published. This study was registered with PROSPERO (international prospective register of systematic reviews) (CRD42022325766). Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). In the meta‐analysis of AUC, 21 studies were pooled for STESS (Status Epilepticus Severity Score), five for EMSE‐EAC (Epidemiology‐based Mortality Score in Status Epilepticus ‐ Etiology, Age, level of Consciousness), five for EMSE‐EACE (EMSE ‐ Etiology, Age, level of Consciousness, EEG), and two for ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation). The pooled AUC of STESS, EMSE‐EAC, EMSE‐EACE, and ENDIT was 0.74 (95% CI: 0.71–0.78), 0.68 (95% CI 0.63–0.72), 0.77 (95% CI: 0.72–0.81), and 0.78 (95% CI: 0.70–0.87), respectively. The pooled sensitivity of STESS‐3, STESS‐4, EMSE‐EACE‐64, and ENDIT‐4 was 0.83 (95% CI: 0.80–0.86), 0.60 (95% CI: 0.55–0.65), 0.76 (95% CI: 0.67–0.83), and 0.70 (95% CI: 0.55–0.82), respectively. Their pooled specificity was 0.50 (95% CI: 0.48–0.52), 0.74 (95% CI: 0.72–0.76), 0.63 (95% CI: 0.59–0.67), and 0.65 (95% CI: 0.61–0.70), respectively. Their pooled PPV was 0.27 (95% CI: 0.24–0.30), 0.35 (95% CI: 0.29–0.41), 0.33 (95% CI: 0.24–0.43), and 0.20 (95% CI: 0.13–0.27). Their pooled NPV was 0.94 (95% CI: 0.93–0.96), 0.90 (95% CI: 0.89–0.92), 0.89 (95% CI: 0.80–0.98), and 0.95 (95% CI: 0.92–0.98). Variations in performance were observed in patients' subgroups, such as critically ill patients and refractory cases. Investigated scores only have acceptable AUC, sensitivity, and specificity for predicting in‐hospital mortality, with the EMSE‐EAC having a lower discriminative power. STESS‐3 has the highest sensitivity, and STESS‐4 the highest specificity, but neither combines acceptable sensitivity and specificity. All these scores had high NPV but very low PPV. Caution should be exercised in their clinical use. Further studies are required to develop more accurate scores. |
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| ISSN: | 15281167 00139580 |
| DOI: | 10.1111/epi.17442 |