Importance 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. Objective To use an independent cohort to validate the 2HELPS2B score and develop a practical guide for its use. Design, Setting, and Participants This multicenter retrospective medical record review analyzed clinical and EEG data from patients 18 years or older with a clinical indication for cEEG and an EEG duration of 12 hours or longer who were receiving consecutive cEEG at 6 centers from January 2012 to January 2019. 2HELPS2B was evaluated with the validation cohort using the mean calibration error (CAL), a measure of the difference between prediction and actual results. A Kaplan-Meier survival 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 (screening) EEG. Participants undergoing elective epilepsy monitoring and those who had experienced cardiac arrest were excluded. No participants who met the inclusion criteria were excluded. Main Outcomes and Measures The main outcome was a CAL error of less than 5% in the validation cohort. Results The study included 2111 participants (median age, 51 years; 1113 men [52.7%]; median EEG duration, 48 hours) 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 during that hour, the CAL error remained at less than 5.0% at 4.2% and allowed for stratifying patients into low- (2HELPS2B = 0; <5% risk of seizures), medium- (2HELPS2B = 1; 12% risk of seizures), and high-risk (2HELPS2B, ≥2; risk of seizures, >25%) groups. Each of the categories had an associated 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. Conclusions and Relevance In this study, 2HELPS2B was validated as a clinical tool to aid in seizure detection, clinical communication, and cEEG use in hospitalized patients. 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 of ≥2), at least 24 hours of recording is recommended.

中文翻译：

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评估2HELPS2B分数对住院癫痫发作风险预测的有效性。

重要的癫痫发作风险分层需要增强住院癫痫发作的检测并提高连续脑电图（cEEG）的成本效益。2HELPS2B可以满足此需求，但需要验证。目的：使用一个独立的队列来验证2HELPS2B得分，并制定实用的使用指南。设计，设置和参加者这项多中心回顾性医疗记录回顾分析了从2012年1月至2012年1月在6个中心接受连续cEEG的18岁以上具有cEEG临床指征且EEG时间为12小时或更长时间的患者的临床和EEG数据。 2019年1月。2HELPS2B与验证队列一起使用均值校准误差（CAL）进行评估，均值校准误差是对预测结果与实际结果之间差异的一种度量。根据在第一小时（筛查）EEG上计算出的2HELPS2B评分，使用Kaplan-Meier生存分析确定EEG监测的持续时间，以使癫痫发作风险小于5％。排除进行选择性癫痫监测的参与者和经历过心脏骤停的参与者。没有符合纳入标准的参与者被排除在外。主要结果和措施主要结果是验证队列中的CAL误差小于5％。结果该研究包括2111名参与者（中位年龄51岁； 1113名男性[52.7％]；中位EEG持续时间48小时），主要结局指标为CAL误差为4.0％，而CAL误差为2.7％。基础队列（P = 0.13）。对于仅在脑电图的第一个小时计算出的2HELPS2B分数，在那一小时内没有癫痫发作的患者，CAL错误的发生率仍低于5.0％（4.2％），并且可以将患者分为低（2HELPS2B = 0；癫痫发作风险小于5％），中（2HELPS2B = 1；癫痫发作风险为12％）和高-危险（2HELPS2B，≥2；癫痫发作的危险，> 25％）组。每个类别均具有相关的建议的最小EEG监测持续时间，以实现至少少于5％的癫痫发作风险，在1小时筛查EEG时2HELPS2B得分为0，在12小时时2HELPS2B得分为1，以及2HELPS2B 24小时得分为2或更高。结论与相关性在这项研究中，2HELPS2B被确认为可帮助住院患者进行癫痫发作检测，临床交流和cEEG使用的临床工具。对于没有先兆临床癫痫发作的患者，筛查1小时无脑电图表现的EEG是足够的筛查。