_id

683a1651c782e11e38d1b341

id

10474

title

2HELPS2B Score

full_title

2HELPS2B Score

short_title

2HELPS2B Score

med_description

Estimates seizure risk in acutely ill patients undergoing continuous EEG (cEEG).

short_description

Seizure risk.

slug

2helps2b-score

description

The 2HELPS2B Score estimates seizure risk in acutely ill patients undergoing continuous EEG (cEEG).

keywords

2HELPS2B Score, seizure risk, EEG, cEEG, continuous EEG, electroencephalogram, seizure probability

complaint

[ "Fecal Incontinence", "Nausea", "Shortness of Breath", "Urinary Incontinence", "Weakness", "Involuntary Movements" ]

formula

The 2HELPS2B Score is calculated by the addition of the selected points:

evidence

measurements

[]

information

Interpretation:

Additional cEEG monitoring:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/29052706/", "text": "Struck AF, Ustun B, Ruiz AR, et al. Association of an electroencephalography-based risk score with seizure probability in hospitalized patients. JAMA Neurol. 2017;74(12):1419-1424." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/31930362/", "text": "Struck AF, Tabaeizadeh M, Schmitt SE, et al. Assessment of the validity of the 2helps2b score for inpatient seizure risk prediction. JAMA Neurol. 2020;77(4):500-507." } ], "Validations": [] }

pearls

• Evaluates for EEG findings of cortical hyperexcitability/irritability, which are associated with seizure risk.

• Accurate scoring requires an EEG interpreter familiar with the American Clinical Neurophysiology Society critical care terminology.

• This tool is not applicable for uses of cEEG unrelated to seizure detection (e.g., ischemia monitoring, post-cardiac arrest prognosis).

• IV sedation may affect results and should be minimized as much as clinically feasible.

usecase

Use in hospitalized adult patients with critical illness undergoing continuous electroencephalogram (cEEG) monitoring who are at risk of non-convulsive or subclinical seizures.

reasons

cEEG is an effective tool for detecting non-convulsive seizures in critically ill patients, as these seizures are associated with worse neurological outcomes and mortality. However, cEEG is resource-intensive, requiring significant labor and cost, which limits its widespread use. This tool can help determine if prolonged cEEG monitoring is warranted, potentially conserving resources in low-risk patients.

next_advice

• This tool does not replace clinical judgment or other diagnostic tools and should only be used as part of a comprehensive assessment.
• Patients should be monitored clinically for any changes that might increase seizure risk.
• Investigate underlying causes of seizures or encephalopathy (e.g., infection, structural lesions, metabolic disturbances).
• Consider rescoring if new findings emerge during cEEG.
• Document the rationale for cEEG continuation or discontinuation.

next_actions

next_management

The following suggestions are based on the validation study by Struck et al. (2020).

• Low risk (0 points): Consider discontinuing cEEG monitoring if no seizures are detected and clinical suspicion is low. Some experts recommend ensuring cEEG has been negative for several hours before discontinuing.
• Medium risk (1 point): Consider discontinuing cEEG monitoring after 12 hours if no seizures are detected and clinical suspicion is low.
• High risk (≥2 points): Continue cEEG monitoring for at least 24 hours.

diseases

[ "Seizure Disorder" ]

input_schema

[ { "conditionality": null, "default": 0, "label_en": "<p><abbr title=\"Brief [ictal] rhythmic discharges\">B[I]RDs</abbr></p>", "mdcalc_info_concept": null, "name": "birds", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 2 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "<p>Presence of <abbr title=\"Lateralized periodic discharges\">LPDs</abbr>, <abbr title=\"Lateralized rhythmic delta activity\">LRDA</abbr>, or <abbr title=\"Bilateral independent periodic discharges\">BIPDs</abbr></p>", "mdcalc_info_concept": null, "name": "lpds", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "<p>Prior seizure</p>", "mdcalc_info_concept": null, "name": "prior", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "<p>Sporadic epileptiform discharges</p>", "mdcalc_info_concept": null, "name": "spor", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "<p>Frequency &gt;2.0 Hz for any periodic or rhythmic pattern</p>", "mdcalc_info_concept": null, "name": "freq", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "radio" }, { "conditionality": null, "default": 0, "label_en": "<p>Presence of &ldquo;plus&rdquo; features&nbsp;</p>", "mdcalc_info_concept": null, "name": "plus", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "i.e., superimposed, rhythmic, sharp, or fast activity", "type": "radio" } ]

instructions

Can be assessed after 1 hour of cEEG monitoring (Struck et al., 2020).

published

2023-04-06T21:22:01.970Z

purpose

[ "Prognosis" ]

search_terms

[ "2HELPS2B Score", "seizure risk", "EEG", "cEEG", "continuous EEG", "electroencephalogram", "seizure probability" ]

seo

{ "keywords_en": "2HELPS2B Score, seizure risk, EEG, cEEG, continuous EEG, electroencephalogram, seizure probability", "meta_description_en": "The 2HELPS2B Score estimates seizure risk in acutely ill patients undergoing continuous EEG (cEEG)." }

specialty

[ "Critical Care", "Critical Care (Neurologic)", "Emergency Medicine", "Hospitalist Medicine", "Internal Medicine", "Neurology" ]

departments

[ "Neurologic" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 10404, "short_title_en": "TRISS", "slug": "trauma-score-injury-severity-score-triss" }, { "calcId": 10503, "short_title_en": "SCORE2-OP", "slug": "score2-older-persons-score2-op" }, { "calcId": 10499, "short_title_en": "SCORE2", "slug": "systematic-coronary-risk-evaluation-score2" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "neurology" ]

cleaned_use

[ "Use in hospitalized adult patients with critical illness undergoing continuous electroencephalogram (cEEG) monitoring who are at risk of non-convulsive or subclinical seizures." ]

pub

false