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

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 needsof 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 ≥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 nonneurological. Patients with mild-to-moderate MS were more likely to present to the ED for issuesdirectly related to MS such as acute exacerbations, while those with severe MS presented moreoften 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 nonneurological 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 patientsevolve over the disease course, as do the resources that must be utilized in providing emergencycare across the spectrum of MS severity. Understanding the characteristics, problems, and needsof MS patients utilizing the ED is an important step in improving care in this population fromboth clinical and public health perspectives.