Validation of the Status epilepticus severity score (STESS) at high-complexity hospitals in Medellín, Colombia.

PURPOSE: The Status Epilepticus Severity Score (STESS) is one of the most well-known clinical scoring systems to predict mortality in status epilepticus (SE). The objective of this study was to validate STESS in a Colombian population. METHOD: We evaluated historical data of adult patients (age ≥16 years) with a clinical or electroencephalographic diagnosis of SE admitted between 2014 and 2017. Prospectively, we included patients admitted from January to June of 2018. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC)-analysis, determination of best cutoff values, sensitivity, specificity, and positive and negative likelihood ratios were performed. RESULTS: The sample was 395 patients, with in-hospital mortality of 16.8 %. The area under the ROC curve for STESS was 0.84. A cutoff point of ≥3 produced the highest sensitivity of 84.9 % (95 % CI 73.9 %-92.5 %) and a specificity of 65.7 % (95 % CI 60.2 %-70.8 %), with a positive likelihood ratio of 2.5 and a negative likelihood ratio of 0.2. CONCLUSIONS: STESS is a useful tool to predict mortality in patients with SE. In Medellin, Colombia, a STESS < 3 allows the identification of the patients who survive reliably. Those patients with a score <3 may have a better prognosis, and treatment with fewer side effects than anaesthetics could be suggested, always remembering the importance of the treating physician's clinical judgement.

Telesalud Y Telemedicina Para El Manejo De La Epilepsia / Telehealth And Telemedicine For The Management Of Epilepsy

Resumen Introducción: La epilepsia es una de las enfermedades neurológicas crónicas más frecuente, con cifras cercanas a los 70 millones de casos a nivel mundial; para la cual la telesalud y la telemedicina se enmarcan como modelos prometedores que pueden traer múltiples beneficios. Objetivo: Evaluar los esquemas iniciales que se han planteado desde la telemedicina y la telesalud en el manejo del paciente con epilepsia y los beneficios que tienen en el manejo. Metodología: Se realizó una búsqueda de literatura científica en (PubMed, Cochrane library y LILACS). Se presentan diferentes modelos de telesalud y telemedicina implementados en el manejo del paciente con epilepsia y se describen los principales beneficios en terminos de aceptabilidad, costos y resultados clínicos. Conclusiones: La investigación actual de estos modelos de atención para el manejo del paciente con epilepsia tiene el potencial de reducir de forma efectiva la brecha de diagnóstico y tratamiento, con posibilidad de reducir los costos en la atención tanto para las instituciones, el sistema de salud, los pacientes y sus familias e integrar de forma armónica la educación en el autocontrol de la enfermedad, demostrando que existe una necesidad de un enfoque más personalizado para estimular el uso de estas herramientas.

Abstract Introduction: Epilepsy is one of the most frequent chronic neurological diseases, with figures close to 70 million cases worldwide; for which telehealth and telemedicine are framed as promising models that can bring multiple benefits. Objective: To evaluate the initial schemes that have been proposed from telemedicine and telehealth in the management of the patient with epilepsy and the benefits that they have in the management. Methods: A search of scientific literature was carried out in (PubMed, Cochrane library and LILACS). Different models of telehealth and telemedicine implemented in the management of patients with epilepsy are presented and the main benefits in terms of acceptability, costs and clinical results are described. Conclusions: Current research of these models of care for the management of patients with epilepsy has the potential to effectively reduce the diagnostic and treatment gap, with the possibility of reducing costs in care for the institutions, the health system, patients and their families and harmoniously integrate with education in the self-control of the disease. Proving that there is a need for a more personalized approach to stimulate the use of these tools