Leitinger “EMSE-score”_electronic supplementary material______page 1
Epidemiology based Mortality score in Status Epilepticus (EMSE) -
Leitinger M1, Höller Y2, Kalss G1, Rohracher A1, Novak HF1, Höfler J1, Dobesberger J1,
Kuchukhidze G1, Trinka E1-3
1 Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria
2 Centre for Cognitive Neuroscience Salzburg, Austria
3 University for Medical Informatics and Health Technology, UMIT, Hall In Tirol, Austria
Corresponding authors:
Univ. Prof. Mag. Dr. Eugen Trinka
Department of Neurology, Christian Doppler Klinik
Paracelsus Medical University of Salzburg,
Ignaz HarrerStraße 79, A- 5020 Salzburg, Austria
Tel. +436624483-3000
Fax +436624483-3004
E-Mail:
Supplementary Table 1Different domains (etiology, age, level of consciousness, duration, EEG and comorbidity) with scoring points, reference and distribution between survivors and deceased.
Etiology E / score / Reference / survived 70 / deceased 22 / p (* sign.<=0.0056)CNS-anomalies / 2 / Wu YW 2002 / 0 / 0 / 1
Drug reduction/ withdrawal; poor compliance / 2 / Wu YW 2002 / 2 (2.9) / 1 (4.5) / 0.56
Multiple sclerosis / 5 / Wu YW 2002 / 0 / 0 / 1
Remotecerebrovasc disease, brain injury / 7 / Wu YW 2002 / 33 (47.1) / 6 (27.3) / 0.138
Hydrocephalus / 8 / Wu YW 2002 / 1 (1.4) / 0 / 1
Alcohol abuse / 10 / Wu YW 2002 / 3 (4.3) / 0 / 1
Drug overdose / 11 / Neligan A 2010 / 0 / 0 / 1
Head trauma / 12 / Neligan A 2010 / 2 (2.9) / 1 (4.5) / 0.56
Cryptogen / 12 / Neligan A 2010 / 6 (8.6) / 2 (9.16) / 1
Brain tumours / 16 / Wu YW 2002 / 6 (8.6) / 2 (9.1) / 1
Metabolic: sodium imbalance / 17 / Wu YW 2002 / 6 (8.6) / 0 / 0.33
Metabolic disorders / 22 / Neligan A 2010 / 4 (5.7) / 2 (9.1) / 0.63
acute cerebrovascular disease: / 26 / Wu YW 2002 / 6 (8.6) / 8 (36.4) / 0.0039 *
CNS-infection: acute / 33 / Wu YW 2002 / 1 (1.4) / 0 / 1
Anoxia / 65 / Wu YW 2002 / 3 (not incl.) / 8 (not incl.)
Age (A)
21-30 / 1 / Koubeissi M 2007 / 5 (7.1) / 0 / 0.33
31-40 / 2 / Koubeissi M 2007 / 8 (11.4) / 1 (4.5) / 0.68
41-50 / 3 / Koubeissi M 2007 / 8 (11.4) / 1 (4.5) / 0.68
51-60 / 5 / Koubeissi M 2007 / 8 (11.4) / 2 (9.1) / 1
61-70 / 7 / Koubeissi M 2007 / 9 (12.9) / 7 (31.8) / 0.055
71-80 / 8 / Koubeissi M 2007 / 19 (27.1) / 6 (27.3) / 0.0515
>80 / 10 / Koubeissi M 2007 / 13 (18.6) / 5 (22.7) / 0.76
Level of consciousness (L) / pretr. / adm. / pretr. / adm. / pretr. / adm.
alert / 0 / Rossetti A 2006 / 12 (17) / 12 (17) / 2 (9) / 4 (18) / 0.51 / 1
somnolent/confused. / 5 / Rossetti A 2006 / 11 (16) / 11 (16) / 6 (27) / 6 (27) / 0.22 / 0.36
stupor / 14 / Rossetti A 2006 / 23 (33) / 23 (33) / 5 (23) / 3 (14) / 0.44 / 0.26
coma / 23 / Rossetti A 2006 / 24 (34) / 24 (34) / 9 (41) / 9 (41) / 0.62 / 0.8
Duration (D)
< 1 h / 3 / Towne AR 1994 / 23 (32.9) / 2 (9.1) / 0.03
>1h / 33 / Towne AR 1994 / 47 (67.1) / 20 (90.9) / 0.03
EEG (E) / strict / strict
Burst suppression (spontan.) / 60 / (Jaitly R 1997) / 0 / 0 / 1 (4.5) / 1 (4.5) / 0.24
ASIDs / 40 / Jaitly R 1997 / 2 (3) / 2 (3) / 1 (4.5) / 1 (4.5) / 0.56
PLEDs / 40 / Jaitly R 1997 / 15 (22) / 10 (14) / 7 (32) / 7 (32) / 0.39 / 0.11
GPDs / 40 / Nei 1999 / 10 (14) / 7 (10) / 11 (50) / 10 (45) / 0.0011 * / 0.0006 *
No PLEDs, GPDs or ASIDs / 0 / Jaitly R 1997 / 45 (64) / 51 (73) / 5 (23) / 6 (27) / 0.0011 * / 0.00027 *
Comorbidity - Charlson (C) / Charlson 1987 / etiology excluded / etiology excluded
Myocardial infarction
Congestive heart failure
peripheral vascular disease cerebrovascular disease dementia
chronic pulmonary disease
connective tissue disease
ulcer disease
mild liver disease
diabetes / 10 / 0
6 (6.5)
4 (4.4)
12 (13.0)
14 (15.2)
7 (7.6)
1 (1.1)
6 (6.5)
7 (7.6)
1 (1.1) / 0
2 (2.9)
3 (4.3)
7 (10.0)
9 (12.9)
4 (5.7)
0
1 (1.4)
3 (4.3)
0 / 0
4 (18.2)
1 (4.5)
5 (22.7)
5 (22.7)
3 (13.6)
1 (4.5)
5 (22.7)
4 (18.2)
1 (4.5 / 1
0.027
1
0.14
0.31
0.35
0.24
0.0027*
0.054
0.04
Hemiplegia,
moderate or severe renal dis.
diabetes with end organ damage,
any tumor including leukemia/lymphoma / 20 / 7 (7.6)
9 (9.8)
13 (14.1)
6 (6.5) / 3 (4.3)
3 (4.3)
8 (11.4)
2 (2.9) / 4 (18.2)
6 (27.3)
5 (22.7)
4 (18.2) / 0.054
0.0052*
0.29
0.027
Moderate or severe liver dis. / 30 / 3 (3.3) / 1 (1.4) / 2 (9.1) / 0.14
Metastatic solid tumor,
AIDS / 60 / 4 (4.3)
0 / 3 (4.3)
0 / 1 (4.5)
0 / 1
0
Level of consciousness was differentiated in “pretreatment - Lp” and “on arrival at hospital- La”, pretr pretreatment, adm admission at hospital, strict: LPDs at least 7/10 s and GPDs at least 9/10 s, p-value corrected for multiple comparisons p<=0.0056 (indicated by *).
Supplementary Table 2Positive predictive value of tested combinations of parameters (etiology, age, comorbidity, EEG, level of consciousness, EEG, and duration of SE) for non-hypoxic patients.
PPV / etio-logy / age / comor-bidity / consc. pretr. / consc. admiss / dura-tion / EEG LPDs, ASIDs / EEG GPDs / EEG LPDs, ASIDs, GPDs / EEG LPDs, ASIDS, GPDs (strict) / EEG LPDs, GPDs (strict)E / A / C / Lp / La / D / Epa / Eg / Epag / Epags / Epgs
- / E: 23.9 / A: 25.3 / C:
23.9 / Lp:
23.9 / La:
23.9 / D:
23.9 / Epa:
23.9 / EACEg:
23.9
E / EA: 24.2
EA / EAC: 44.0 / EALp: 25.0 / EALa: 25.0 / EAD: 27.8 / EALpa: 29.3 / EAEg: 24.2
EAC / EACLp: 35.5 / EACLa: 32.8 / EACD: 36.7 / EACEpa: 36.7 / EACEg: 45.8 / EACEpag: 55.0 / EACEpags: 66.7 / EACE: 68.8
EACLp / 43.1 / 31 / 50.0 / 52.4 / 66.7 / 61.1
EACLa / 42.3 / 29.7 / 51.2 / 53.7 / 61.1 / 61.1
EACD / 33.3 / 47.8 / 40.7 / 47.8 / 48.9
EACDLp / 36.1 / 53.7 / 43.1 / 53.7 / 55.0
EACDLa / 36.1 / 51.2 / 43.1 / 51.2 / 52.4
STESS-3 / 27.0 %
STESS-4 / 32.4 %
E etiology, Aage, Ccomorbidity, Lp level of consciousness pretreatment, La level of consciousness on admission, D duration, E EEG, p LPDs/lateralized periodic discharges, g GPDs/generalized periodic discharges, a ASIDs/after status ictal discharges, strict this stricter interpretation required LPDs to occur at least as seven sharply contoured complexes per ten seconds and GPDs at least as nine complexes per ten second EEG epoch, counted on epoch with highest frequency.
Supplementary Table 3 Analysis of mortality rates of different levels of consciousness (pretreatment) and correctly classified in EACE in semiological subgroups.
”all GCSE” / “all FMSE” / “NCSEonly” / CONVonly / NCSEall / all non-hypoxiccorrectly classified
EACE / 92.3 / 87.5 / 85.7 / 95.9 / 81.4 / 89.1
mortality
total / 25.6 / 18.8 / 28.6 / 16.3 / 32.6 / 23.9
awake / 0 / 20 / 20 / 4.3 / 14.3 / 14.3
somnolent / 50 / 12.5 / 60 / 20.0 / 41.7 / 35.3
stupor / 20 / 12.5 / 20 / 15.0 / 25 / 17.9
coma / 31.3 / 27.3 / 16.7 / 17.6 / 37.5 / 27.3
“all GCSE” “GCSE evolving into NCSE” and “GCSE not evolving into NCSE”;
“all FMSE” “FMSE evolving to NCSE” and “FMSE not evolving into NCSE”;
“NCSE only” NCSE as only semiology,
“CONVonly” SE with convulsions only, no NCSE in semiological sequence: “GCSE not evolving to NCSE” and “FMSE not evolving into NCSE”;
“NCSEall” SE with semiology including NCSE: NCSE as only presenting semiology, and “GCSE evolving to NCSE”, and “FMSE evolving to NCSE”;
Supplementary Text 1 The following EEG-criteria were used for EEG-confirmation of NCSE: epileptiform discharges (ED) > 2.5 Hz, or EDs ≤ 2.5 Hz or rhythmic delta/theta activity (>0.5 Hz) AND one of the following: (i) EEG and clinical improvement after IV AED, or (ii) subtle clinical ictal phenomena, or (iii) typical spatiotemporal evolution [16].