National Characterization of Bell's Palsy Management in the Emergency Department 2006 to 2022

OBJECTIVE: The emergency department (ED) is frequently the first point of care for patients presenting with acute facial paralysis. Characterizing current practice patterns may reveal opportunities in adherence to evidence-based guidelines for management of acute Bell's palsy. This study evaluates ED management of Bell's palsy using a nationally representative sample of visits. STUDY DESIGN: Retrospective cross-sectional study. SETTING: National Hospital Ambulatory Medical Care Survey (NHAMCS), 2006 to 2022, capturing nationwide US ED visits. METHODS: Independent variables include sex and race/ethnicity. Primary outcomes assess adherence to guideline-recommended management, including corticosteroid therapy (with or without antivirals) and use of diagnostic neuroimaging. NHAMCS provided demographic, diagnostic, procedural, and treatment data. Management differences were evaluated using chi-square testing and multivariable logistic regression, adjusting for age, insurance status, comorbidities, and urban/rural location. RESULTS: An estimated 1.68 million Bell's palsy ED visits occurred from 2006 to 2022. Corticosteroids were administered in 64.1% of total visits, and 6.3% (N = 104,848 visits) received antivirals alone. Diagnostic imaging was performed in 49.8% of visits, despite guideline recommendations against routine imaging, with variation by race and ethnicity (P = .016); imaging was most frequent among Asian and White patients. Female and Black or Hispanic patients had lower adjusted odds of receiving imaging compared to male and White patients, respectively. Most visits (86.1%) resulted in referral for follow-up care, though referral practices varied. CONCLUSIONS: As the ED serves as the primary entry point for most Bell's palsy cases, these findings highlight important opportunities to improve adherence to evidence-based management across all demographic groups. LEVEL OF EVIDENCE: IV.