Emergency Department visits before the diagnosis of MS

Prompt diagnosis and early initiation of disease-modifying treatment improves long-term outcomes in MS patients. This study looks at the path to MS diagnosis from the Emergency Department (ED), a frequent point of access for healthcare.

To evaluate how patients presenting to the Mount Sinai ED with initial manifestations of MS are ultimately diagnosed with demyelinating disease.

Retrospective, observational analysis of all patients diagnosed with MS from 2005 to 2009. Part of the Resource Utilization in MS (RESUMS) Study.

Urban, tertiary care center Emergency Department

Forty-nine patients were diagnosed with MS during the study period and made a total of 98 ED visits prior to that diagnosis.

Outcome measures included percentage of ED visits for neurologic symptoms, percentage that were likely initial manifestations of MS, percentage of visits admitted, mean length of hospital stay of those patients admitted, time until MS diagnosis, and time until initiation of disease modifying agent. Demographic and presentation-specific features correlating with time until MS diagnosis were evaluated.

69.4% of patients were female. Mean age was 32.9 years (range 16-56). Hispanics comprised 40.8%, African Americans 28.6%, and Caucasians 18.2%. 59.2% of patients had private insurance, 26.5% Medicaid, and 6.1% Medicare. 50% of ED visits (49) were for neurologic symptoms (sensory symptoms 44.9%, vision changes 26.5%, weakness 24.5%, imbalance 16%, diplopia and vertigo 10.2%). 75.5% of the ED visits for neurologic symptoms were admitted; mean length of stay was 5.7 days (range 1-18). MS or demyelinating disease was diagnosed at the time of the ED visit or admission in 30/49 (61.2%) of neurologic presentations, with 73.5% diagnosed within a week. In the remaining 26.6%, MS diagnosis was delayed. 18.4% were diagnosed within a year of their neurologic ED visit and 8.2% remained undiagnosed at 1 year. Disease modifying agents were started in 71.4% of patients, 77.1% within 6 months.

ED presentations for acute neurologic symptoms are an important opportunity to diagnose and treat early MS, and while the majority of the patients studied were appropriately triaged, diagnosed and treated in a timely manner, there exists room for improvement.