Abstract Details

Title Reduced Time to Treatment After Implementation of a Standardized Guideline for the Diagnostic Evaluation and Acute Management of Suspected Autoimmune Encephalitis in Hospitalized Adult Patients

Topic Autoimmune Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-018

Objective To assess the impact of institutional guidelines directing the approach to the diagnosis and acute management of autoimmune encephalitis (AE) in hospitalized adults.

Background AE is a neuroimmunologic condition manifesting as subacute neuropsychiatric decline, often accompanied by seizures, movement disorders, and/or dysautonomia. Its heterogenous phenotypic spectrum poses diagnostic challenges. Prompt recognition and timely treatment initiation are associated with improved outcomes. Lack of expertise may lead to unnecessary or duplicative high-cost testing, delays in diagnosis and management, and/or misdiagnoses. Implementation of institutional guidelines may improve appropriate testing and optimize care delivery.

Design/Methods Suspected AE cases in hospitalized adults were identified retrospectively by whether a serum autoimmune encephalopathy panel was ordered 7 months prior to and 7 months following the guideline implementation in July 2021. Defined demographic and outcome variables were compared between pre- and post-implementation cohorts. Time to treatment start was defined by duration from hospital admission to receipt of empiric first-line treatment (e.g., methylprednisolone or intravenous IgG).

Results 269 unique cases met inclusion criteria for the entire study period [median age 66 years pre- and 60 years post-implementation]. Case characteristics including median mRS at evaluation, frequency of encephalopathy, psychiatric features, epileptic seizures, ICU level of care and associated malignancies, were comparable between the cohorts. A clinical diagnosis of AE (autoantibody-positive or negative) was confirmed in 10 (6.8%) pre-implementation cases and in 10 (8.3%) post-implementation cases (p=0.64). Average time to treatment was reduced from 13.3 days (SD 21.0) pre-implementation cohort to 6.1 days (SD 7.3) post-implementation (AFT p=0.025).

Conclusions

Institutional guidelines outlining the diagnostic evaluation and acute management of AE positive impacted care. Although a majority in each cohort did not ultimately have a confirmed AE diagnosis, thus warranting ongoing educational initiatives and encouragement of guideline utilization, a slight improvement in diagnostic accuracy was found.

Authors/Disclosures
Giovanna Manzano, MD PRESENTER	Dr. Manzano has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gilead Sciences. Dr. Manzano has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for InfuCare Rx.
Samuel J. Steuart	Mr. Steuart has nothing to disclose.
Prashanth Rajarajan, MD, PhD (Brigham and Women's Hospital)	Dr. Rajarajan has nothing to disclose.
Bruna Leles Vieira de Souza, MD (Work)	Miss Leles Vieira de Souza has nothing to disclose.
Rachel Rodin, MD, PhD	Dr. Rodin has nothing to disclose.
Leigh Rettenmaier, MD	Dr. Rettenmaier has nothing to disclose.
Caleb R. McEntire, MD (MGH-Brigham Neurology)	Dr. McEntire has nothing to disclose.
Ahmad Mashlah, MBBS (Mass General Brigham)	Dr. Mashlah has nothing to disclose.
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital)	Dr. Bilodeau has or had stock in Roche. The institution of Dr. Bilodeau has received research support from Alexion Pharmaceuticals. The institution of Dr. Bilodeau has received research support from Department of Defense. Dr. Bilodeau has received research support from Canadian Institutes of Health Research. The institution of Dr. Bilodeau has received research support from Ann Theodore Foundation. Dr. Bilodeau has received research support from The MOG Project.
Leah L. Wibecan, MD, MPH	Dr. Wibecan has nothing to disclose.
Jenny Linnoila, MD, PhD (University Neurology Associates, UPMC)	Dr. Linnoila has received personal compensation in the range of $10,000-$49,999 for serving as a expert respondent on autoimmune encephalitis with U.S. government/DHHS/Vaccine Injury Compensation Program.