J Clin Neurol.  2014 Jul;10(3):216-221. 10.3988/jcn.2014.10.3.216.

Emergency Medical Care of Multiple Sclerosis Patients: Primary Data from the Mount Sinai Resource Utilization in Multiple Sclerosis Project

• Oynhausen
• Alcauskas
• Hannigan C
• Bencosme Y
• Muller M
• Lublin F
• Krieger S

• KMID: 2179448
• DOI: http://doi.org/10.3988/jcn.2014.10.3.216

Abstract

BACKGROUND AND PURPOSE
There has been no systematic analysis of emergency department (ED) utilization in the multiple sclerosis (MS) population. We investigated the acute-care needs of MS patients using ED as a route for entry into healthcare services.
METHODS
ED visits made by MS patients were identified. Data extracted included demographics, medical/neurological history, and workup/management in the ED.
RESULTS
The Mount Sinai ED received 569 visits from 224 MS patients during a 3-year period, of whom 33.5% were covered by Medicaid and 12.9% were uninsured. Patients with an Expanded Disability Status Scale score of > or =6 accounted for 54%, 50.5% of relapsing remitting MS patients were being treated with disease-modifying therapies, and 74.5% of the ED visits were non-neurological. Patients with mild-to-moderate MS were more likely to present to the ED for issues directly related to MS such as acute exacerbations, while those with severe MS presented more often due to medical issues indirectly related to MS, such as urinary tract infections (p<0.0001).
CONCLUSIONS
Most MS patients seeking ED care suffer from acute non-neurological problems. The MS patients presenting to the ED tended to be underinsured, had high levels of disability, and were undertreated with disease-modifying therapies. The acute-care needs of MS patients evolve over the disease course, as do the resources that must be utilized in providing emergency care across the spectrum of MS severity. Understanding the characteristics, problems, and needs of MS patients utilizing the ED is an important step in improving care in this population from both clinical and public health perspectives.

Keyword

multiple sclerosis; underinsured; emergencies; healthcare access; utilization

MeSH Terms

Delivery of Health Care
Demography
Emergencies*
Emergency Medical Services
Emergency Service, Hospital
Humans
Medicaid
Medically Uninsured
Multiple Sclerosis*
Public Health
Urinary Tract Infections

Figure

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  Fig. 1 Breakdown of insurance types.

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  Fig. 2 Neurological and nonneurological chief complaints. CCs: chief complaints, GI: gastrointestinal.

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  Fig. 3 EDSS severity by relationship of emergency diagnosis to MS. DVT: deep vein thrombosis, EDSS: Expanded Disability Status Scale, MS: multiple sclerosis, SOB: shortness of breath, URI: upper respiratory infection, UTI: urinary tract infection.

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