Multiple Sclerosis in the Emergency Department: A Retrospective Case-Control Study in a Large US Center

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Emergency department (ED) utilization among multiple sclerosis (MS) patients is understudied despite advancements in high-efficacy disease-modifying therapies (DMTs).
• Comorbidities and social determinants of health may significantly influence ED access in individuals with MS.

Purpose of the Study:

• To identify the primary reasons for ED visits in patients with MS.
• To determine risk factors associated with ED utilization, including sociodemographic characteristics, comorbidity burden, and DMT efficacy.

Main Methods:

• A retrospective case-control study analyzed 900 patients with MS (300 cases with ED visits, 600 controls without ED visits) from June 2019 to December 2023.
• Regression models assessed associations between sex, age, race, insurance, Charlson Comorbidity Index (CCI), and DMT efficacy category with ED visit likelihood.

Main Results:

• Higher Charlson Comorbidity Index (CCI) scores (OR=4.23) were the strongest predictor of ED visits.
• Not using disease-modifying therapies (DMTs) (OR=2.56) and public/no insurance (OR=1.99) increased ED visit likelihood.
• Racial minority status was associated with a lower likelihood of ED visits (OR=0.48).

Conclusions:

• Significant risk factors for ED use exist in the multiple sclerosis population.
• Comprehensive comorbidity management and clinical pathways to address DMT non-use are recommended to reduce ED visits.