“In the general population, it has been shown that frequent users of the emergency department strain the healthcare system, resulting in higher costs, overcrowding, and decreased quality of health care,” Drs. Krieger and Alcauskas reported.
During the three-year study period, 224 patients made 569 visits, with a mean of 2.5 visits among all patients. Twenty-one patients were defined as high-frequency users, with six or more visits each. The researchers found no significant difference in demographics between frequent and nonfrequent users; however, frequent users were more likely to have a longer disease duration and a history of psychiatric issues.
Frequent users were more likely than nonfrequent users to present with hardware malfunction, such as urinary catheters, urinary complaints, and fever.
“This study has identified several presentation-specific, and therefore, modifiable factors affecting high-frequency emergency department usage in the MS population,” the researchers wrote. “Unlike studies in other chronic medical conditions, no social or demographic factors were found to be significantly associated with high-frequency emergency department usage.”
Relapses constituted a small fraction of emergency department visits, representing just 13.2% of visits. Of the 75 visits in which patients presented with relapse, 43 were admissions to the hospital, with an average length of stay of 8.5 days. As noted in the study presented at AAN, emergency department doctors frequently misdiagnosed patients with MS as having a relapse or other neurologic event.
“Of patients thought to have MS relapses by the emergency department that turned out to be incorrectly diagnosed, 40% ended up having a urinary tract infection,” Dr. Krieger noted. “This is a diagnosis easily ruled out in the emergency department with a simple urinalysis and culture, and this finding underscores the need for a basic evaluation in the emergency department in all MS patients.”