IH Registry Study on Emergency Department Usage by IIH Patients
IH Registry Study Examines Emergency Department Usage by IIH Patients
An IH Registry study examining emergency department (EDs) usage by previously diagnosed idiopathic intracranial patients has been published in the International Journal of Health Care Quality Assurance. Since IIH can be a debilitating disorder that is difficult to identify and treat, a failure to manage IIH symptoms may force patients to present at Eds seeking symptom relief.
The researchers sought to characterize ED use by previously diagnosed IIH patients, a subject that has received little attention but is important to all IH patients, physicians, researchers, administrators, health policy officials and others .
This study includes information from 332 individuals with IIH enrolled in the IHR, and analyzed a 3-year period to understand the influence that untreated/undertreated symptoms and socioeconomic factors have on the use of ED facilities.
The researchers discovered socioeconomic and health insurance factors play an important role in ED utilization: respondents who were non-white, lived in households with incomes below $25,000 and were insured by Medicare or Medicaid were not only more likely to use the ED, but also used it much more frequently than those in higher socioeconomic households
Additionally, among the IIH participants in this study, 39 percent utilized emergency services during the three-year study period and averaged nine visits.
Headaches were reported as a reason for seeking ED treatment in 90 percent of the ED visits for which this information was reported, while blurred vision was a reason given for 43 percent of such visits to the ED. CSF shunting procedures and complications with such procedures were additional factors associated with ED utilization. Over half of respondents who had received a CSF diversional shunt at some points used the ED, which may suggest insufficient symptom control or an adverse reaction.
In general, IIH patients seeking care in the ED found it to be inadequate or unsatisfactory. IIH symptom management is complex and only 21 percent of patients utilizing the ED reported that ED staff was familiar with IH or IH treatment, and only 36 percent felt that their symptoms were taken seriously.
Often, the only services ED staff can offer IIH patients are a lumbar puncture in selected circumstances to temporarily decrease the CSF pressure, narcotics for pain, or referral based on findings and general lack of response to treatment. Over 60 percent of respondents reported that they received a narcotic from ED staff; however, approximately half of respondents felt that they were perceived as being drug seekers.
Addressing the issues of healthcare access and effective symptom management in private healthcare settings may reduce ED utilization among IIH patients. Importantly, future research efforts should lead to more effective clinical treatment plans, both medical and surgical, that can better accomplish improved CSF pressure control.
Ultimately improved pressure control reduces pain management and increases preservation of vision, which should in turn significantly decrease the need for IIH patients to seek ED treatment.