Makkawi Seraj, Maglan Alaa, Khojah Osama, Allaf Faris, Alamoudi Saeed, Ahmed Mohamed Eldigire, Alsharif Rawaf, Altayeb Meral, Alharthi Abdulrhman, Abulaban Ahmad, Al Malik Yaser
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Front Neurol. 2024 Apr 26;15:1395822. doi: 10.3389/fneur.2024.1395822. eCollection 2024.
Multiple sclerosis (MS) patients are no strangers to the emergency department (ED) due to the relapsing and progressive nature of the disease and the associated complications. This study aimed to identify patterns of ED visits among patients diagnosed with MS, the underlying causes of these visits, and the factors associated with these visits.
This was a single center retrospective cohort study which utilized a non-probability consecutive sampling technique to include all patients diagnosed with MS (471 patients) from March 2016 to October 2021 in King Abdulaziz Medical City, Jeddah, Saudi Arabia. ED visits were categorized as directly related to MS, indirectly related to MS, or unrelated to MS.
One in four people with MS visited the ED at least once with a total of 280 ED visits. Most ED visits were ones directly related to MS 43.6%, closely followed by unrelated to MS 41.1%, and then indirectly-related MS visits 15.4%. The most common presenting symptoms in directly-related MS visits were weakness 56.6% and numbness/tingling 56.6% followed by gait impairment 29.5%. Indirectly related to MS or unrelated to MS ED visits were commonly due to neurological 17.7% and gastrointestinal 17.1% causes. Using disease modifying therapy (DMT) was significantly associated with no ED visits ( < 0.001). The use of high-efficacy DMTs was significantly associated with no ED visits than using moderate efficacy DMT ( < 0.001). The use of B-cell depleting therapy (ocrelizumab and rituximab) was significantly associated with no visits to the ED than using any other DMT ( < 0.001). Evidence of brain atrophy on imaging was significantly associated with patients who presented to the ED ≥3 times ( = 0.006, UOR = 3.92).
Due to the nature of the disease, many MS patients find themselves visiting the ED due to MS related and unrelated issues. These patients are not only required to be treated by neurologists but also by multiple disciplines. The use of high-efficacy DMTs and B-cell depleting therapy may reduce the total frequency of ED visits. Special attention should be paid to patients who have evidence of brain atrophy on imaging.
由于多发性硬化症（MS）具有复发和进展的特性以及相关并发症，MS患者对急诊科（ED）并不陌生。本研究旨在确定确诊为MS的患者的急诊就诊模式、这些就诊的潜在原因以及与这些就诊相关的因素。
这是一项单中心回顾性队列研究，采用非概率连续抽样技术纳入了2016年3月至2021年10月在沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城确诊为MS的所有患者（471例）。急诊就诊被分类为与MS直接相关、与MS间接相关或与MS无关。
四分之一的MS患者至少去过一次急诊科，总共进行了280次急诊就诊。大多数急诊就诊与MS直接相关（43.6%），其次是与MS无关（41.1%），然后是与MS间接相关的就诊（15.4%）。与MS直接相关的就诊中最常见的症状是无力（56.6%）和麻木/刺痛（56.6%），其次是步态障碍（29.5%）。与MS间接相关或与MS无关的急诊就诊常见原因是神经方面（17.7%）和胃肠道方面（17.1%）。使用疾病修正治疗（DMT）与无急诊就诊显著相关（<0.001）。与使用中等疗效的DMT相比，使用高效DMT与无急诊就诊显著相关（<0.001）。与使用任何其他DMT相比，使用B细胞清除疗法（奥瑞珠单抗和利妥昔单抗）与无急诊就诊显著相关（<0.001）。影像学上脑萎缩的证据与就诊≥3次的患者显著相关（=0.006，UOR=3.92）。
由于疾病的性质，许多MS患者因与MS相关和无关的问题前往急诊科。这些患者不仅需要神经科医生治疗，还需要多个学科的治疗。使用高效DMT和B细胞清除疗法可能会减少急诊就诊的总频率。对于影像学上有脑萎缩证据的患者应给予特别关注。
