Comparison of STESS and M-STESS Scoring as Predictors of Mortality in Status Epilepticus: A Retrospective Cohort Study

Abstract

Background: Status Epilepticus (SE) is a neurological emergency with high morbidity and mortality. Accurate early predictions of death are essential to guide clinical management, especially in resource-constrained settings. STESS and m-STESS are assessment systems developed to stratify the severity of SE and predict short- and medium-term mortality. Objective: This study aimed to compare the performance of STESS and m-STESS in predicting 7-day and 30-day mortality among SE patients and to evaluate their clinical utility in the emergency department. Methods: A retrospective cohort study was conducted at Prof. Dr. R. D. Kandou Hospital Manado, Indonesia, including 90 patients diagnosed with SE. Clinical and demographic data were collected from medical records, including levels of consciousness, seizure type, previous history, and mRS scores. Predictive performance was analyzed using ROC curves, calculating sensitivity, specificity, positive and negative predictive values, and total accuracy. Comparisons between STESS and m-STESS were conducted for 7-day and 30-day mortality outcomes. Results: The 7-day mortality rate was 35.6% and increased to 56.7% at 30 days. m-STESS showed higher sensitivity and accuracy (90.6%) (83.3% at 30 days) compared to STESS (82.2% at 30 days). ROC analysis showed m-STESS had superior predictive performance, especially for 30-day mortality, although the difference at 7 days was not statistically significant. Both scores correlated significantly with mortality, and higher scores were observed among patients who died. Conclusion: m-STESS provides a more accurate tool for predicting SE mortality and can improve clinical decision-making in emergency settings. Further multicenter studies are recommended to validate and optimize the scoring system.