Abstract Details

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.

To use an independent cohort to validate the 2HELPS2B score and develop a practical guide for its use.

This multicenter retrospective medical record review analyzed clinical and EEG data from adult patients with an EEG duration of 12 hours or longer at 6 centers from January 2012 to January 2019. 2HELPS2B was evaluated with the validation cohort using the mean calibration error (CAL). A Kaplan-Meier 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 EEG.

The study included 2111 participants 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 the patients were stratified into low- (2HELPS2B = 0; <5%), medium- (2HELPS2B = 1; 12%), and high-risk (2HELPS2B,2; risk of seizures, >25%) groups. Each had 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.

In this study, 2HELPS2B was validated as a clinical tool to aid in seizure detection, clinical communication, and cEEG use. 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 of2), at least 24 hours of recording is recommended.