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| Dean Reinke Deans' Stroke Musing |
And maybe if ER departments had objective tests for stroke this wouldn't be quite such a big concern.
Abstract
Background and Purpose:
Dizziness is a frequent reason for neuroimaging and neurological consultation, but little is known about the utility of either practice. We sought to characterize the patterns and yield of neuroimaging and neurological consultation for dizziness in the emergency department (ED).Methods:
We retrospectively identified consecutive adults presenting to an academic ED from 2007 to 2009, with a primary complaint of dizziness, vertigo, or imbalance. Neurologists reviewed medical records to determine clinical characteristics, whether a neuroimaging study (head computed tomography [CT] or brain magnetic resonance imaging [MRI]) or neurology consultation was obtained in the ED, and to identify relevant findings on neuroimaging studies. Two neurologists assigned a final diagnosis for the cause of dizziness. Logistic regression was used to evaluate bivariate and multivariate predictors of neuroimaging and consultation.Results:
Of 907 dizzy patients (mean age 59 years; 58% women), 321 (35%) had a neuroimaging study (28% CT, 11% MRI, and 4% both) and 180 (20%) had neurological consultation. Serious neurological disease was ultimately diagnosed in 13% of patients with neuroimaging and 21% of patients with neurological consultation, compared to 5% of the overall cohort. Headache and focal neurological deficits were associated with both neuroimaging and neurological consultation, while age ≥ 60 years and prior stroke predicted neuroimaging but not consultation, and positional symptoms predicted consultation but not neuroimaging.Conclusion:
In a tertiary care ED, neuroimaging and neurological consultation were frequently utilized to evaluate dizzy patients, and their diagnostic yield was substantial.Introduction:
Dizziness is one of the most common triage complaints in the emergency department (ED), accounting for approximately 3% of visits.1. Most cases of acute dizziness or vertigo are related to benign causes, such as peripheral vestibular dysfunction.
1-5. However, a small proportion of cases are due to central causes, particularly posterior fossa strokes, which if missed, could lead to severe disability or death.
1,2,6,7. This general concern for uncommon but serious causes of dizziness often leads to extensive workups for acutely dizzy patients in the ED that include neuroimaging studies or neurological consultation.
8,9. However, little is known about the prevalence or utility of either practice, and there are no published data about the clinical factors that are associated with requests for imaging or consultation. A better understanding of the factors associated with these management decisions and the usefulness of these costly and time-consuming tests is a necessary step toward improving the overall efficiency and cost-effectiveness of these evaluations
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