title: Emergency Department visits before the diagnosis of MS.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  To evaluate how patients presenting to the Mount Sinai ED with initial manifestations of MS are ultimately diagnosed with demyelinating disease.
  
  
  METHODS
  Retrospective, observational analysis of all patients diagnosed with MS from 2005 to 2009. Part of the Resource Utilization in MS (RESUMS) Study.
  
  
  METHODS
  Urban, tertiary care center Emergency Department
  
  
  METHODS
  Forty-nine patients were diagnosed with MS during the study period and made a total of 98 ED visits prior to that diagnosis.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: 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. Electronic address: rebecca.straus-farber@mssm.edu.
authors: Rebecca
authors: R
authors: Farber
authors: 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. Electronic address: christine.hannigan@mssm.edu.
authors: Christine
authors: C
authors: Hannigan
authors: 3004B Poston Avenue, Nashville, TN 37203-1314, USA. Electronic address: megan.alcauskas@gmail.com.
authors: Megan
authors: M
authors: Alcauskas
authors: 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. Electronic address: stephen.krieger@mssm.edu.
authors: Stephen
authors: S
authors: Krieger
keywords: Delayed diagnosis; Emergencies; Health care access; Multiple Sclerosis; Patient outcome assessment; Utilization