Monday, 4 August 2014

MS-related hospitalizations fall

MS-related hospitalisations falls. Why? #MSBlog #MSResearch

"I was at our London MS Group meeting earlier this year and was having a general discussion about how uncommon it is to see MSers admitted with relapses. Most agreed with this anecdotal observation.When we do see hospital admissions as a result of an MS attack it is usually due to a severe brainstem or spinal cord attack as the initial presentation of MS, or CIS, (clinically-isolated syndromes). In other words in MSers who are not on DMTs. The other major reasons for admission are MS-related complications,  typically severe UTIs, pneumonia, constipation, fractures and falls, suicide attempts and pressure sores. Thankfully the latter is now rare, but tragically still occurs."
"Even relapses that we see and document in outpatients are much less severe than they were 10-15 years ago. Why? I am sure it is because of DMTs; DMTs not only reduce the frequency of relapses, but appear to reduce the severity as well. Most DMTs reduce the proportion of relapses requiring hospitalisations and/or steroid treatment, which are both metrics of relapse severity. Has this been  your experience?"

"The study below showing a significant fall-off in MSers requiring hospitalisation over the last 25 years and supports my anecdotal observations above. My personal experience, and data like that presented below, has led me to the realisation  that DMTs are changing the natural history of MS. I am also convinced as the uptake of more effective DMTs increases the prognosis of MS will continue to improve. Those of us who have been in the field to remember the pre-DMT era know this already. Unfortunately, there is still a lot to be done."


"If you have time can you please complete this quick survey to see if we can assess whether or not we can confirm this trend? Thanks."



OBJECTIVE: We aimed to describe hospitalizations in the MS population, and to evaluate temporal trends in hospitalizations in the MS population compared to the general population.

METHODS: Using population-based administrative data, we identified 5,797aMSers and a matched general population cohort of 28,769 persons. Using general linear models, we evaluated temporal trends in hospitalization rates and length of stay in the 2 populations over the period 1984-2011.

RESULTS: In 1984 the hospitalization rate was 35 per 100 person-years in the MS population and 10.5 in the matched population (relative risk [RR] 3.33; 95% confidence interval: 1.67-6.64). Over the study period hospitalizations declined 75% in the MS population but only 41% in the matched population. The proportion of hospitalizations due to MS declined substantially from 43.4% in 1984 to 7.8% in 2011. The 3 most common non-MS-related reasons for admission in the MS population were diseases of the digestive, genitourinary, and circulatory systems. Admissions for bacterial pneumonia, influenza, urinary tract infections, and pressure ulcers occurred more often in the MS population than in the general population, while admissions for circulatory system disease and neoplasms occurred less often. Older age, male sex, and lower socioeconomic status were associated with increased hospitalization rates for non-MS-related reasons.

CONCLUSIONS: Although hospitalization rates have declined dramatically in the MS population over the last quarter century, they remain higher than in the general population. Admissions for MS-related reasons now constitute only a small proportion of the reasons for hospitalization.

2 comments:

  1. I have never been given DMTs. might the advice to keep moving/exercise have made a small difference and perhaps high dose Vit D for those of us unlucky enough to have missed the DMT boat?

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  2. Many years ago we were told to have bed rest when we had an attack and were admitted to hospital when we couldn't cope. I moved home so that I could manage any exacerbation more easily. I soon realised that for me carrying on and not giving in worked for me. My colleagues thought I had new illnesses. Sometimes I didn't bother to go to the doctor because there was no point. I have friends that did the same. When I was admitted to hospital, I usually ended up in the dementia ward. I never had DMTs, I just didn't think that being admitted did me more harm than good.

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