The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus

• Published in: European journal of neurology Vol. 26; no. 5; pp. 760 - e55
• Main Authors: Requena, M., Fonseca, E., Olivé, M., Abraira, L., Quintana, M., Mazuela, G., Toledo, M., Salas‐Puig, X., Santamarina, E.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-05-2019
• Subjects: Coma; Confidence intervals; Convulsions & seizures; Deviation; Diagnosis; Emergency medical services; Epilepsy; Paresis; Patients; pre‐hospital; scale; Seizures; Speech; status epilepticus; pre-hospital; status epilepticus; scale
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.13885

Background and purpose
The prognosis of status epilepticus (SE) depends on the time between onset and the diagnosis and start of treatment. Our aim was to design a scale with predictive value for pre‐hospital diagnosis of SE.
Methods
This was a retrospective study of 292 patients who attended the emergency department for an epileptic seizure. A total of 49 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.
Results
A total of 50.3% of the patients were male and the mean age was 55.9 years. The following features were more prevalent in patients with SE: 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 pre‐hospital seizures, i.e. two (34.7% vs. 4.5%, P < 0.001) or more than two (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 two seizures, and 2 points for more than two seizures. The predictive capacity of the scale for identifying SE in the validation dataset was 98.7% (95% confidence interval, 97.3%–100%) and 85.4% of patients with a score >1 had SE.
Conclusions
A score >1 on the 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.