{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T05:26:52Z","timestamp":1787203612422,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T00:00:00Z","timestamp":1734739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["RF\u20102016\u201002361365"],"award-info":[{"award-number":["RF\u20102016\u201002361365"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The STEPPER (Status Epilepticus in Emilia\u2010Romagna) study aimed to investigate the clinical characteristics, prognostic factors, and treatment approaches of status epilepticus (SE) in adults of the Emilia\u2010Romagna region (ERR), Northern Italy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>STEPPER, an observational, prospective, multicentric cohort study, was conducted across neurology units, emergency departments, and intensive care units of the ERR over 24\u2009months (October 2019\u2013October 2021), encompassing incident cases of SE. Patients were followed up for 30\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 578 cases were recruited (56% female, mean age\u2009=\u200970\u2009years, 32% with previous diagnosis of epilepsy, 43% with in\u2010hospital onset, 35% stuporous\/comatose, 46% with nonconvulsive SE). Etiology was known in 87% (acute 43%, remote 24%, progressive 17%, definite epileptic syndrome 3%). The mean pre\u2010SE Rankin Scale score was 2, the Status Epilepticus Severity Score was \u22654 in 33%, the Epidemiology\u2010Based Mortality Score in Status Epilepticus score was \u226564 in 61%, and 34% were refractory. The sequence of treatments followed current clinical practice guidelines in 63%. Benzodiazepines (BDZs) were underused as first\u2010line therapy (71%), especially in in\u2010hospital onset cases; 15% were treated with continuous intravenous anesthetic drugs. Mortality was 24%; 63% of survivors had functional worsening. At the two\u2010step multivariable analysis, incorrect versus correct treatment sequence with correct BDZ dose was the strongest predictor of failure to resolve SE in the in\u2010hospital group (odds ratio [OR] =\u20094.42, 95% confidence interval [CI] =\u20091.86\u201310.5), with a similar trend in the out\u2010of\u2010hospital group (OR\u2009=\u20092.22, 95% CI = .98\u20135.02). In turn, failure to resolve was the strongest predictor of 30\u2010day mortality (OR\u2009=\u200911.3, 95% CI\u2009=\u20094.16\u201330.9, out\u2010of\u2010hospital SE; OR\u2009=\u20096.42, 95% CI\u2009=\u20092.79\u201314.8, in\u2010hospital SE) and functional worsening (OR\u2009=\u20095.83, 95% CI\u2009=\u20092.05\u201316.6, out\u2010of\u2010hospital SE; OR\u2009=\u20099.30, 95% CI 2.22\u201332.3, in\u2010hospital SE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>The STEPPER study offers insights into real\u2010world SE management, highlighting its significant morbidity and functional decline implications. Although nonmodifiable clinical factors contribute to SE severity, modifiable factors such as optimized first\u2010line therapies and adherence to guidelines can potentially influence prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.18227","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T09:09:28Z","timestamp":1734772168000},"page":"753-767","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Prognostic factors and impact of management strategies for status epilepticus: The\n                    <scp>STEPPER<\/scp>\n                    study in the Emilia\u2010Romagna region, Italy"],"prefix":"10.1111","volume":"66","author":[{"given":"Lidia","family":"Di Vito","sequence":"first","affiliation":[{"name":"IRCCS Istituto Delle Scienze Neurologiche di Bologna full member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE)  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Matteo","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Delle Scienze Neurologiche di Bologna full member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE)  Bologna Italy"},{"name":"Department of Biomedical and Neuromotor Sciences University of Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0334-539X","authenticated-orcid":false,"given":"Stefano","family":"Meletti","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Zenesini","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Delle Scienze Neurologiche di Bologna full member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE)  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Bernab\u00e8","sequence":"additional","affiliation":[{"name":"Neurology Unit Rimini \u201cInfermi\u201d Hospital  Rimini Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Bomprezzi","sequence":"additional","affiliation":[{"name":"Neurology Unit Ospedale Maurizio Bufalini  Cesena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Chiara","family":"Casadio","sequence":"additional","affiliation":[{"name":"Intensive Care Unit IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Alberto","family":"Castioni","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Delle Scienze Neurologiche di Bologna full member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE)  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Cesnik","sequence":"additional","affiliation":[{"name":"Neurology Unit University Hospital of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Coniglio","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive Care, and Prehospital Emergency Maggiore Hospital  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Curr\u00f2\u2010Dossi","sequence":"additional","affiliation":[{"name":"Neurology Unit Rimini \u201cInfermi\u201d Hospital  Rimini Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"De Massis","sequence":"additional","affiliation":[{"name":"Struttura Semplice Dipartimentale di Neurologia Ospedale Santa Maria Della Scaletta  Imola Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Fallica","sequence":"additional","affiliation":[{"name":"Neurology Unit University Hospital of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Florindo","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3585-5872","authenticated-orcid":false,"given":"Giada","family":"Giovannini","sequence":"additional","affiliation":[{"name":"Neurophysiology Unit and Epilepsy Center Azienda Ospedaliero\u2010Universitaria di Modena  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Guarino","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Complessa Clinica Neurologica Rete Neurologica Metropolitana Unit\u00e0 Operativa Semplice Neurologia S. 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