341 Emergency Department Visits for Bell’s Palsy Have Increased in New Jersey, a Lyme-Endemic Area

Abstract

Bell's palsy is a common emergency department (ED) diagnosis, frequently attributed to viral etiologies and to Lyme disease in some regions. We previously showed that 16% of patients with Bell's palsy had confirmed Lyme disease in a Lyme endemic area of New Jersey (NJ). According to the Centers for Disease Control and Prevention, the number of cases of Lyme disease in NJ has changed little between 2006 and 2014. We therefore hypothesized that there would have been no change in the annual number of ED visits for Bell’s palsy. Design: Multi center retrospective cohort of ED visits. Setting: 7 NJ suburban EDs with annual visits from 26,000 to 97,000. Population: Consecutive patients seen by emergency physicians from 1/1/1999 to 12/31/2015. Protocol: We identified visits for Bell’s palsy using International Classification of Diseases codes. Data Analysis: We computed the number of visits for Bell’s palsy by year over the time period of the study. We then calculated the annual percentage of ED visits with Bell's palsy. We used percentage rather than total number of visits for Bell's palsy, as ED visits increased by 61% from 1999 to 2015 in the EDs included. Most of this increase was due to closure of other hospitals in the area. We plotted the percentage ED visits for Bell's palsy versus year and calculated the change from 1999 to 2015 and the linear coefficient R squared of the plot. Of the 6,199,347 total visits, there were 5328 (0.086%) with Bell’s palsy. The mean age was 43 +/- 20 years. Females comprised 49%. The annual percentages of ED visits for Bell's palsy in 1999 and 2015 were 0.071% and 0.097%, respectively. This represents a relative increase of 38% (95% confidence interval: 16% - 63%). For the plot of annual percentage versus year, the linear coefficient R squared = 0.65 (p < 0.0001). Contrary to our hypothesis, we found a marked increase in ED visits for Bell’s palsy from 1999 to 2015. Since the incidence of Lyme disease was essentially unchanged, our findings may reflect increases in other etiologies for Bell’s palsy such as viruses. Further research may help inform treatment choices for Bell's palsy patients in the ED.