Multiple Sclerosis as Differential Diagnosis in ED


Review of MRI in the emergency department compared rates of MS as differential diagnosis and final diagnosis.

Magnetic resonance images from the emergency department (ED) can lead to early guidance for a diagnosis of a demyelinating disorder, according to study published in the American Journal of Roentgenology.

Researchers from The Johns Hopkins Medical Institutions in Baltimore, MD, performed a retrospective study to examine the potential value of the radiologists' MR imaging reports for patients with previously undiagnosed multiple sclerosis (MS) who presented to the ED.

The researchers reviewed electronic medical records of 61 women and 31 men (mean age of 41.2) who underwent imaging with their institution’s ED MRI scanner, and for whom the radiologist reported a possible demyelinating disorder.

The results showed for 48 of the 92 patients (52.2%), the radiology report suggested a demyelinating diagnosis and the patient was given this diagnosis as the final outcome. Where a demyelinating disorder was placed as the only, first, second, or third (or later) differential diagnosis, the final diagnosis was concordant with demyelination in 43 of 51 patients (84.3%), three of eight patients (37.5%), two of 11 patients (18.2%), and zero of 22 patients (0%), respectively.

The researchers concluded that radiologist-suggested demyelinating disease as the top differential diagnosis after MRI showed a high concordance rate with demyelinating disease as the final diagnosis. Having such findings from scans in the ED for neurologic deficits can lead to early guidance for a diagnosis of demyelination to be made, resulting in downstream effects, such as reduced admission rates, avoidance of unnecessary use of other procedures, and early commencement of disease-modifying therapy.

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