STEPSS and PEDSS Scores for Predicting Short-Term Outcome in Children with Febrile Status Epilepticus: A Prospective Observational Study

Abstract

Background: Febrile status epilepticus (FSE) is a high-priority paediatric emergency because prolonged seizures may be followed by delayed neurological recovery, seizure recurrence, or death. Early, bedside prognostication is particularly useful in busy public-sector emergency units where escalation decisions have to be made quickly.

Objective: To assess the predictive value of the Status Epilepticus Pediatric Severity Score (STEPSS) and Pediatric Early Determinants of Status Score (PEDSS) for short-term outcome in children with FSE, and to examine their relationship with electroencephalographic findings, magnetic resonance imaging findings, drug refractoriness, seizure semiology, and Pediatric Cerebral Performance Category Scale (PCPCS)-based outcome assessment.

Methods: This prospective observational study was conducted over 12 months, from May 2024 to May 2025, in the Paediatric Emergency Room of Government Chengalpattu Medical College, Tamil Nadu, India. Children aged 6 months to below 5 years presenting with FSE were enrolled consecutively after informed consent. STEPSS was calculated at admission and PEDSS within 48 hours. EEG, MRI, treatment response and short-term outcome until discharge or death, with 7-14 day post-event follow-up where applicable, were recorded. Descriptive statistics, chi-square/t-test associations and multivariable analysis were used.

Results: Among 100 children, 58% were boys and the largest age group was 1 to below 3 years (52%). Generalized tonic-clonic seizures were observed in 78%, seizure duration exceeded 60 minutes in 32%, refractory status epilepticus occurred in 20%, and super-refractory status epilepticus in 5%. EEG abnormalities were present in 68%, while MRI abnormalities were seen in 42%, most commonly hippocampal signal change (14%). Favourable outcome, unfavourable neurological outcome and mortality occurred in 68%, 26% and 6%, respectively. Lower STEPSS and PEDSS categories were associated with better outcome. Multivariable analysis identified refractory status epilepticus (OR 8.4), STEPSS >3 (OR 6.2), PEDSS >=3 (OR 5.8), hippocampal MRI abnormality (OR 4.3), and EEG background slowing (OR 3.6) as independent predictors of poor outcome.

Conclusion: STEPSS and PEDSS were practical predictors of short-term outcome in children with FSE. STEPSS may support early emergency triage, while PEDSS adds value after EEG, treatment response and systemic severity become available. Children with high scores, refractory seizures, background EEG slowing or hippocampal MRI change require early escalation, close counselling and structured neurodevelopmental follow-up.