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Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction.

Publication ,  Journal Article
Struck, AF; Tabaeizadeh, M; Schmitt, SE; Ruiz, AR; Swisher, CB; Subramaniam, T; Hernandez, C; Kaleem, S; Haider, HA; Cissé, AF; Dhakar, MB ...
Published in: JAMA Neurol
April 1, 2020

IMPORTANCE: Seizure risk stratification is needed to boost inpatient seizure detection and to improve continuous electroencephalogram (cEEG) cost-effectiveness. 2HELPS2B can address this need but requires validation. OBJECTIVE: To use an independent cohort to validate the 2HELPS2B score and develop a practical guide for its use. DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective medical record review analyzed clinical and EEG data from patients 18 years or older with a clinical indication for cEEG and an EEG duration of 12 hours or longer who were receiving consecutive cEEG at 6 centers from January 2012 to January 2019. 2HELPS2B was evaluated with the validation cohort using the mean calibration error (CAL), a measure of the difference between prediction and actual results. A Kaplan-Meier survival analysis was used to determine the duration of EEG monitoring to achieve a seizure risk of less than 5% based on the 2HELPS2B score calculated on first- hour (screening) EEG. Participants undergoing elective epilepsy monitoring and those who had experienced cardiac arrest were excluded. No participants who met the inclusion criteria were excluded. MAIN OUTCOMES AND MEASURES: The main outcome was a CAL error of less than 5% in the validation cohort. RESULTS: The study included 2111 participants (median age, 51 years; 1113 men [52.7%]; median EEG duration, 48 hours) and the primary outcome was met with a validation cohort CAL error of 4.0% compared with a CAL of 2.7% in the foundational cohort (P = .13). For the 2HELPS2B score calculated on only the first hour of EEG in those without seizures during that hour, the CAL error remained at less than 5.0% at 4.2% and allowed for stratifying patients into low- (2HELPS2B = 0; <5% risk of seizures), medium- (2HELPS2B = 1; 12% risk of seizures), and high-risk (2HELPS2B, ≥2; risk of seizures, >25%) groups. Each of the categories had an associated minimum recommended duration of EEG monitoring to achieve at least a less than 5% risk of seizures, a 2HELPS2B score of 0 at 1-hour screening EEG, a 2HELPS2B score of 1 at 12 hours, and a 2HELPS2B score of 2 or greater at 24 hours. CONCLUSIONS AND RELEVANCE: In this study, 2HELPS2B was validated as a clinical tool to aid in seizure detection, clinical communication, and cEEG use in hospitalized patients. In patients without prior clinical seizures, a screening 1-hour EEG that showed no epileptiform findings was an adequate screen. In patients with any highly epileptiform EEG patterns during the first hour of EEG (ie, a 2HELPS2B score of ≥2), at least 24 hours of recording is recommended.

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Published In

JAMA Neurol

DOI

EISSN

2168-6157

Publication Date

April 1, 2020

Volume

77

Issue

4

Start / End Page

500 / 507

Location

United States

Related Subject Headings

  • Seizures
  • Risk Assessment
  • Retrospective Studies
  • Monitoring, Physiologic
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Female
  • Electroencephalography
 

Citation

APA
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Struck, A. F., Tabaeizadeh, M., Schmitt, S. E., Ruiz, A. R., Swisher, C. B., Subramaniam, T., … Westover, M. B. (2020). Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction. JAMA Neurol, 77(4), 500–507. https://doi.org/10.1001/jamaneurol.2019.4656
Struck, Aaron F., Mohammad Tabaeizadeh, Sarah E. Schmitt, Andres Rodriguez Ruiz, Christa B. Swisher, Thanujaa Subramaniam, Christian Hernandez, et al. “Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction.JAMA Neurol 77, no. 4 (April 1, 2020): 500–507. https://doi.org/10.1001/jamaneurol.2019.4656.
Struck AF, Tabaeizadeh M, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T, et al. Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction. JAMA Neurol. 2020 Apr 1;77(4):500–7.
Struck, Aaron F., et al. “Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction.JAMA Neurol, vol. 77, no. 4, Apr. 2020, pp. 500–07. Pubmed, doi:10.1001/jamaneurol.2019.4656.
Struck AF, Tabaeizadeh M, Schmitt SE, Ruiz AR, Swisher CB, Subramaniam T, Hernandez C, Kaleem S, Haider HA, Cissé AF, Dhakar MB, Hirsch LJ, Rosenthal ES, Zafar SF, Gaspard N, Westover MB. Assessment of the Validity of the 2HELPS2B Score for Inpatient Seizure Risk Prediction. JAMA Neurol. 2020 Apr 1;77(4):500–507.

Published In

JAMA Neurol

DOI

EISSN

2168-6157

Publication Date

April 1, 2020

Volume

77

Issue

4

Start / End Page

500 / 507

Location

United States

Related Subject Headings

  • Seizures
  • Risk Assessment
  • Retrospective Studies
  • Monitoring, Physiologic
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Female
  • Electroencephalography