Guidelines for Neuroprognostication in Critically Ill Adults with Status Epilepticus
Neurocritical Care Society · 2026 · USA
Source and licence
- Authors
- Dominik Madzar, Venkatakrishna Rajajee, Susanne Muehlschlegel et al.
- Title
- Guidelines for Neuroprognostication in Critically Ill Adults with Status Epilepticus
- Journal
- Neurocritical Care, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC13053593
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Good Practice Statement 1
- We recommend that clinicians establish with patient surrogates the most appropriate long-term goals of care in individual patients with SE. Such goals, which may range from control of seizures to a return to functional independence, should serve as the basis for prognostication in an individual patientstrong recommendation, evidence cannot be graded
Good Practice Statement 4
- We recommend that in patients with SE and an established underlying etiology, validated predictors of outcome specific to the underlying disease serve as a basis for neuroprognosticationstrong recommendation, evidence cannot be graded
Good Practice Statement 5
- We recommend that neuroprognostication, when feasible, should be performed in the absence of potential confounders of the neurological examination, such as residual sedation, a toxic-metabolic encephalopathy or prolonged postictal encephalopathystrong recommendation, evidence cannot be graded
Good Practice Statement 6
- We recommend that in patients with SE of unclear etiology neuroprognostication be deferred until an appropriate diagnostic evaluation is performed for the underlying disease process. Evaluation should be timely and, when feasible, be performed concurrently with treatment of seizures, as etiology may determine appropriate treatment and prognosisstrong recommendation, evidence cannot be graded
Abstract
Background: Status epilepticus (SE) is a heterogeneous disorder with significant morbidity and mortality. This guideline provides broad principles of neuroprognostication and recommendations on the reliability of clinical predictors of outcome that clinicians may consider when counseling surrogate decision-makers of patients with SE.
Methods: This narrative systematic review used Grading of Recommendations Assessment, Development and Evaluation methodology. Good practice recommendations addressed essential principles of neuroprognostication. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and the availability of appropriate evidence. The question was: “When counseling surrogates of patients with SE, should [predictor, with time of assessment if appropriate] be considered a reliable predictor of [outcome] assessed at [time point]?” Outcomes were selected and rated by the panel. Screening criteria were used to exclude smaller and lower-quality studies. Following construction of the evidence profile and summary of findings, recommendations were based on four Grading of Recommendations Assessment, Development and Evaluation criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use.
Results: Good practice recommendations include establishing appropriate long-term goals with surrogates of patients with SE that may extend beyond seizure control alone, setting expectations for recovery in patients with refractory/super-refractory SE, using predictors specific to underlying pathologies as a basis for neuroprognostication, considering potential confounders, and deferring neuroprognostication in cases of unclear etiology until appropriate diagnostic evaluation is performed. Nine clinical variables and two prediction models were selected. A sufficient body of evidence was available only for the prediction of mortality. Forty-two articles met the eligibility criteria for guiding recommendations. None of the variables and models selected were identified as reliable predictors of mortality in patients with SE.
Conclusions: This guideline provides broad principles for neuroprognostication and recommendations on the reliability of predictors of in-hospital mortality in the context of counseling surrogates of patients with SE.
Supplementary Information: The online version contains supplementary material available at 10.1007/s12028-025-02425-8.
Contents of the original publication
The section headings of the original.
- Introduction
- Scope, Purpose, and Target Audience
- How to Use these Guidelines
- Methods
- Selection of Guideline Questions
- Selection of Outcomes
- Systematic Review Methodology
- Evidence to Recommendation Criteria
- Good Practice Statements
- Recommendations: Clinical Variables as Predictors
- Outcome: in-Hospital Mortality
- Recommendations: Clinical Prediction Models
- Outcome: In-Hospital Mortality
- Future Directions
- Conclusions
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