Abstract Details

Title Emergency Department Visits before the Diagnosis of MS (Data from RESUMS-D: Resource Utilization in MS Diagnosis)

Topic MS and Related Diseases

Presentation(s) P03 - (-)

Poster/Presentation
Number 206

Objective

Background BACKGROUND: Modern diagnostic criteria have allowed for MS to be diagnosed promptly and disease-modifying treatment initiated expeditiously. Patients often rely on the Emergency Department (ED) as a point of access for healthcare, particularly for acute presentations of illness. How MS is diagnosed following ED presentations in a real-world setting has not been comprehensively evaluated.

Design/Methods DESIGN/METHODS: Mount Sinai patients diagnosed with MS from 2005- 2009 were identified, and all ED visits made by these patients prior to their MS diagnosis were reviewed. Diagnostic tests and timing of diagnostic and treatment milestones were captured.

Results RESULTS: 98 ED visits were made by 49 patients before they were diagnosed with MS. 69.4% were female. Mean age was 32.9 years (range 16-56). Hispanics comprised 40.8%, African Americans 28.6%, and Caucasians 18.2%. Precisely 50% of ED visits (49) were for neurologic symptoms (sensory 44.9%, vision changes 26.5%, weakness 24.5%, imbalance 16%, diplopia and vertigo 10.2%, respectively). 43.9% of all ED visits were classified as likely the initial manifestation of MS (CIS). Of all neurologic presentations, the ED made a diagnosis of MS or possible MS in only 10.2%, no diagnosis in 57.1%, and an incorrect diagnosis in 16.3%. 75.5% of the ED visits for neurologic symptoms were admitted; mean length of stay was 5.8 days. MS was diagnosed during admission in 30/49 (61.2%) of neurologic presentations. In the remaining 39.8%, diagnosis was delayed: 31.6% of them were not diagnosed by 6 months.

Conclusions CONCLUSIONS: ED presentations for acute neurologic symptoms are an important opportunity to diagnose and treat CIS, and there is room to make the diagnosis of MS both more accurately and more rapidly.

Authors/Disclosures
Rebecca G. Straus Farber, MD (Columbia University Irving Medical Center) PRESENTER	Dr. Straus Farber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics.
	No disclosure on file
Megan C. Alcauskas, MD	No disclosure on file
Tracy T. Batchelor, MD, MPH (Brigham and Women's Hospital)	Dr. Batchelor has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up To Date, Inc. An immediate family member of Dr. Batchelor has received publishing royalties from a publication relating to health care. Dr. Batchelor has received publishing royalties from a publication relating to health care.
	No disclosure on file
Stephen Krieger, MD, FAAN (Mount Sinai Dept of Neurology)	Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle. The institution of Dr. Krieger has received research support from Novartis. The institution of Dr. Krieger has received research support from Bristol Myers Squibb. The institution of Dr. Krieger has received research support from Biogen. The institution of Dr. Krieger has received research support from Sanofi.

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