Farber Rebecca, Hannigan Christine, Alcauskas Megan, Krieger Stephen
Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, 5 East 98th St, Box 1138, New York, NY 10029, USA.
3004B Poston Avenue, Nashville, TN 37203-1314, USA.
Mult Scler Relat Disord. 2014 May;3(3):350-4. doi: 10.1016/j.msard.2013.11.004. Epub 2013 Dec 1.
Prompt diagnosis and early initiation of disease-modifying treatment improves long-term outcomes in MS patients. This study looks at the path to MS diagnosis from the Emergency Department (ED), a frequent point of access for healthcare.
To evaluate how patients presenting to the Mount Sinai ED with initial manifestations of MS are ultimately diagnosed with demyelinating disease.
Retrospective, observational analysis of all patients diagnosed with MS from 2005 to 2009. Part of the Resource Utilization in MS (RESUMS) Study.
Urban, tertiary care center Emergency Department
Forty-nine patients were diagnosed with MS during the study period and made a total of 98 ED visits prior to that diagnosis.
Outcome measures included percentage of ED visits for neurologic symptoms, percentage that were likely initial manifestations of MS, percentage of visits admitted, mean length of hospital stay of those patients admitted, time until MS diagnosis, and time until initiation of disease modifying agent. Demographic and presentation-specific features correlating with time until MS diagnosis were evaluated.
69.4% of patients were female. Mean age was 32.9 years (range 16-56). Hispanics comprised 40.8%, African Americans 28.6%, and Caucasians 18.2%. 59.2% of patients had private insurance, 26.5% Medicaid, and 6.1% Medicare. 50% of ED visits (49) were for neurologic symptoms (sensory symptoms 44.9%, vision changes 26.5%, weakness 24.5%, imbalance 16%, diplopia and vertigo 10.2%). 75.5% of the ED visits for neurologic symptoms were admitted; mean length of stay was 5.7 days (range 1-18). MS or demyelinating disease was diagnosed at the time of the ED visit or admission in 30/49 (61.2%) of neurologic presentations, with 73.5% diagnosed within a week. In the remaining 26.6%, MS diagnosis was delayed. 18.4% were diagnosed within a year of their neurologic ED visit and 8.2% remained undiagnosed at 1 year. Disease modifying agents were started in 71.4% of patients, 77.1% within 6 months.
ED presentations for acute neurologic symptoms are an important opportunity to diagnose and treat early MS, and while the majority of the patients studied were appropriately triaged, diagnosed and treated in a timely manner, there exists room for improvement.
及时诊断并尽早开始疾病修正治疗可改善多发性硬化症（MS）患者的长期预后。本研究探讨了从急诊科（ED）开始的MS诊断路径，急诊科是医疗保健的常见就诊点。
评估以MS初始表现就诊于西奈山急诊科的患者最终如何被诊断为脱髓鞘疾病。
对2005年至2009年所有被诊断为MS的患者进行回顾性观察分析。MS资源利用研究（RESUMS）的一部分。
城市三级医疗中心急诊科
在研究期间，49名患者被诊断为MS，在该诊断之前共进行了98次急诊科就诊。
结局指标包括因神经症状进行急诊科就诊的百分比、可能为MS初始表现的百分比、就诊后入院的百分比、入院患者的平均住院时间、直至MS诊断的时间以及直至开始使用疾病修正药物的时间。评估了与直至MS诊断时间相关的人口统计学和特定表现特征。
69.4%的患者为女性。平均年龄为32.9岁（范围16 - 56岁）。西班牙裔占40.8%，非裔美国人占28.6%，白种人占18.2%。59.2%的患者有私人保险，26.5%有医疗补助，6.1%有医疗保险。50%的急诊科就诊（49次）是因神经症状（感觉症状44.9%，视力改变26.5%，虚弱24.5%，失衡16%，复视和眩晕10.2%）。因神经症状进行急诊科就诊的患者中，75.5%入院；平均住院时间为5.7天（范围1 - 18天）。在49次因神经症状就诊中，有30次（61.2%）在急诊科就诊或入院时被诊断为MS或脱髓鞘疾病，其中73.5%在一周内被诊断。在其余26.6%的病例中，MS诊断被延迟。18.4%在其神经科急诊科就诊后一年内被诊断，8.2%在1年后仍未被诊断。71.4%的患者开始使用疾病修正药物，77.1%在6个月内开始使用。
因急性神经症状进行急诊科就诊是早期诊断和治疗MS的重要机会，虽然大多数研究患者得到了适当的分诊、及时诊断和治疗，但仍有改进空间。
