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Initial Treatment and Referral Patterns for Acute Facial Palsy: Insights From Emergency Department Practices
Christine C Little1, Rahul K Sharma1, Alexander Barna1
1Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
The Laryngoscope
|May 14, 2025
Summary
Bell's Palsy treatment varies by patient age, insurance, and race, with disparities noted in emergency department care. Provider type also influences management, highlighting a need for standardized protocols to ensure equitable treatment.
Area of Science:
- Neurology
- Emergency Medicine
- Health Services Research
Background:
- Bell's Palsy, a common cause of acute facial paralysis, requires timely and guideline-adherent management.
- Variations in treatment protocols can lead to suboptimal patient outcomes and healthcare disparities.
Purpose of the Study:
- To examine disparities in Bell's Palsy treatment and referrals within an academic Emergency Department (ED).
- To identify sociodemographic and provider-related factors influencing management decisions for acute facial paralysis.
Main Methods:
- Retrospective cohort review of 887 patients diagnosed with Bell's Palsy or acute facial paralysis (2017-2024).
- Analysis of management practices including steroids, antivirals, imaging, and specialty consultations.
- Multivariable logistic regression to identify factors associated with treatment variations.
Main Results:
- Hispanic patients and those with Medicare/Medicaid were less likely to receive recommended therapies (imaging, bimodal treatment).
- Older patients were more likely to undergo imaging.
- Trainees (residents/fellows) were more prone to ordering specialty consults and imaging compared to attending physicians.
Conclusions:
- Significant disparities in Bell's Palsy initial management exist based on age, insurance, race, and provider type.
- Standardizing treatment guidelines and enhancing provider awareness are crucial for equitable care delivery.
