Author(s)
Manuela von Sneidern, MD
Arman Saeedi, MPH
Audrey M. Abend, BA
Ethan Wiener, MD
Silas Smith, MD
Danielle F. Eytan, MD
Affiliation(s)
Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine (Saeedi, von Sneidern, Abend); Department of Emergency Medicine, New York University Grossman School of Medicine (Wiener, Smith); Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine (Eytan);
Abstract:
Background: The majority of patients with acute facial paralysis, such as Bell’s Palsy, present initially to the Emergency Room. AAOHNS Bell’s Palsy guidelines recommend oral steroids, eye care, and patient follow-up. It remains unclear, however, if patients who present to emergency department with facial palsy receive care that adheres to these guidelines.
Learning/Study Objectives: This study aims to characterize acute facial palsy treatment and referral patterns in emergency rooms within a single institution.
Design type: retrospective chart review
Method: We conducted a retrospective chart review of 269 patients diagnosed with acute facial nerve paralysis in the emergency departments of an academic tertiary care center between 6/01/2021 - 6/01/2022. Information pertaining to patient demographics, comorbidities, workup, management, and referral patterns were extracted and analyzed.
Results: A total of 269 patients met inclusion criteria. Although most adults received some form of steroid treatment (n=230, 91.3%), only 69.30% received the appropriate course based on published AAOHNS guidelines. Antivirals were prescribed to 74.21% of adults, and 98.41% received eye care counseling. Providers advised specialist follow-up in 64.49% of adults, though less than 10% were discharged with a referral. Only 58.8% of children were advised to follow-up and none received specialist referral.
Conclusion: While guidelines for the treatment of acute facial nerve palsy exist, they are not always widely known or easily accessed across specialties. In high pace and volume environments such as the Emergency Department, there is room for optimization in the treatment of these patients.