{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T11:40:12Z","timestamp":1794483612761,"version":"4.9.1"},"reference-count":30,"publisher":"SAGE Publications","issue":"13","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"MS Canada","award":["EGID:P002\/903124\/3743"],"award-info":[{"award-number":["EGID:P002\/903124\/3743"]}]},{"DOI":"10.13039\/100000890","name":"National MS Society","doi-asserted-by":"publisher","award":["RG5063A4\/1\/RFA-2103-37392"],"award-info":[{"award-number":["RG5063A4\/1\/RFA-2103-37392"]}],"id":[{"id":"10.13039\/100000890","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Emergency department (ED) visits represent a substantial component of healthcare use. Although increased utilization has been reported before multiple sclerosis (MS) recognition, ED use and its clinical context remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this population-based matched cohort study, we used linked administrative health data from British Columbia, Canada. Persons with multiple sclerosis (PwMS) were identified using a validated case definition and matched to individuals without MS by age, sex and postal code. ED encounters in the 5 years preceding the index date (first demyelinating disease claim) were examined. Annual ED visit rates were compared using adjusted negative binomial models; discharge diagnoses were assessed using adjusted logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The cohort included 2383 PwMS and 11,896 matched individuals (mean age\u2009=\u200944.1\u2009years; 69.2% female). ED visit rates were higher among PwMS across all five pre-index years, rising from an adjusted rate ratio (aRR) of 1.38 (95% confidence interval (CI)\u2009=\u20091.07\u20131.77) at 5 years pre-index to 3.40 (95% CI\u2009=\u20093.07\u20133.76) in the year immediately pre-index. Excess visits were observed for gastrointestinal, genitourinary, musculoskeletal, respiratory, mental health, and ill-defined conditions. PwMS had higher odds of a non-specific discharge diagnosis (adjusted odds ratio (aOR)\u2009=\u20091.36; 95% CI = 1.22\u20131.53).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ED utilization was consistently elevated in the 5 years before MS recognition (index date), predominantly involving non-neurologic and non-specific presentations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261475120","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T05:38:17Z","timestamp":1786426697000},"page":"1375-1383","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency department use before multiple sclerosis: Presenting complaints and discharge diagnoses"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-0684","authenticated-orcid":false,"given":"Marta","family":"Ruiz-Alguer\u00f3","sequence":"first","affiliation":[{"name":"Faculty of Medicine (Neurology), The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-9378","authenticated-orcid":false,"given":"Yinshan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"},{"name":"School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9491-0851","authenticated-orcid":false,"given":"Farahnaz","family":"Amini","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-5595","authenticated-orcid":false,"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Neurology), Health Sciences Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada"},{"name":"Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5804-2535","authenticated-orcid":false,"given":"Helen","family":"Tremlett","sequence":"additional","affiliation":[{"name":"Faculty of Medicine (Neurology), The University of British Columbia and Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2010.16.9.703"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1212\/WN9.0000000000000033"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2013.11.004"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30076-5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.07.002"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2025.106595"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.24635"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.70092"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.52267"},{"key":"e_1_3_3_11_2","unstructured":"Canadian Institute for Health. 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