The ADAN scale for the identification of status epilepticus: A multicentre prospective study

Resumen

Objective: Status epilepticus (SE) is a severe disease complicated by high mortality and poor functional outcome in survivors. This study aims to prospectively validate the ADAN scale, which was recently proposed to identify patients at a high risk of developing SE.

Method: We conducted a prospective, multicentre, observational cohort study involving adult patients with suspected epileptic seizures. Consecutive recruitment was performed for 27 months at the emergency departments of four hospitals. The endpoint was the proportion of patients fulfilling the criteria for SE. We collected and analysed clinical characteristics and ADAN scale score upon patients’ arrival at the emergency department.

Results: 527 patients were recruited: 203 (38.5%) met SE criteria. In multiple regression analysis, Abnormal speech, ocular Deviation, Automatisms, and the Number of motor epileptic seizures were shown to be the only clinical variables independently associated with the final diagnosis of SE (p <0.001). The predictive capacity of the scale was 90.9% (95% confidence interval, 88.4%-93.4%) to identify SE as final diagnosis. We established three risk groups based on the scores: low (ADAN 0-1: 8.7%), moderate (ADAN 2: 46.6%), and high (ADAN >2: 92.6%). A cut-off score of >1 yielded 88.2% sensitivity, 77.8% specificity, 71.3% positive predictive value, and 91.3% negative predictive value for predicting SE.

Conclusions: The ADAN scale is a simple, prospectively validated clinical tool for identifying patients at high risk of SE. Further research is necessary to examine the effects and outcomes of implementing the ADAN scale in the triage and management of suspected SE.