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The ADAN Scale: A proposed scale for prehospital use to identify status epilepticus.

Research paper by Manuel M Requena, Elena E Fonseca, Marta M Olivé, Laura L Abraira, Manuel M Quintana, Gonzalo G Mazuela, Manuel M Toledo, Xavier X Salas-Puig, Estevo E Santamarina

Indexed on: 20 Dec '18Published on: 20 Dec '18Published in: European Journal of Neurology



Abstract

Prognosis of status epilepticus (SE) depends on the time between the onset and the diagnosis and start of treatment. Our aim was to design a scale with predictive value for prehospital diagnosis of SE. Retrospective study of 292 patients attended in emergency department for an epileptic seizure. Forty-nine patients fulfilled the criteria for SE. We recorded the patients' history and clinical features. 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. In total, 50.3% were men and mean age was 55.9 years. The following features were more prevalent in SE patients: abnormal speech (79.6% vs 18.9%, p<0.001), eye deviation (69.4% vs 14.0%, p<0.001), automatism (22.4% vs 6.3%, p<0.001), hemiparesis (24.5% vs 10.9%, p=0.011), state of stupor/coma (46.9% vs 4.2%, p<0.001), and number of prehospital seizures 2 (34.7% vs 4.5%, p<0.001) or more than 2 (51.0% vs 0.4%, p<0.001). Based on these findings, we designed a scale that scored 1 point each for presence of abnormal speech, eye deviation, automatism, and 2 seizures, and 2 points for >2 seizures. The predictive capacity of the scale for identifying SE in the validation dataset was 98.7% (95% CI 97.3%-100%); 85.4% of patients with a score >1 had SE. A score >1 on ADAN scale is a robust predictor of the diagnosis of SE in patients who experience an epileptic seizure. This scale may be a useful tool for clinical use and warrants further investigation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.