Predictive Performance of STEPSS in Pediatric Status Epilepticus

Abstract

To evaluate the predictive performance of the Status Epilepticus in Pediatric Patients Severity Score (STEPSS) in predicting short-term functional outcomes in children presenting with status epilepticus (SE).

This ambispective study was conducted in a tertiary pediatric intensive care unit over 18 months. Seventy-six children, aged 1 month to 18 years, presenting with SE, were enrolled. The STEPSS was calculated at admission. This scoring system was adapted from prior pediatric studies with appropriate permissions. It encompasses factors such as consciousness, seizure type, age, and a history of previous seizures. Outcomes were assessed using the Pediatric Overall Performance Category (POPC) scale at discharge and 3-month follow-up. The predictive ability of STEPSS was evaluated using sensitivity, specificity, and receiver operating characteristic analysis.

Of the 76 patients, 36 (47%) had an acute, symptomatic etiology. The median STEPSS was 2 (interquartile range: 1–3), with 36.8% of participants having a score greater than 2. Poor neurological outcomes (POPC scores >2) were noted in 31 (40.8%) children at discharge and 25 (33.7%) at follow-up. STEPSS >2 predicted unfavorable outcomes both at discharge and at 3-month follow-up. STEPSS >2 predicted poor outcomes at discharge with an area under the curve of 0.760 (95% confidence interval: 0.65–0.82, p < 0.001), yielding 75% accuracy, 64% sensitivity, 82% specificity, positive predictive value of 71%, and a negative predictive value of 77%.

The STEPSS >2 shows a moderate predictive performance of functional outcomes in children with SE at discharge and at 3-month follow-up, with clinically useful sensitivity and specificity. This tool can provide insight for management and may serve as a practical bedside tool.