Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies

Objectives: Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods: We retrospectively revie...

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Published in:Journal of community hospital internal medicine perspectives 2017-03, Vol.7 (2), p.73-78
Main Authors: Ammar, Hussam, Govindu, Rukma, Fouda, Ragai, Zohdy, Wael, Supsupin, Emilio
Format: Article
Language:English
Subjects:
Abnormalities
Ataxia
Brain
Complaints
Computed tomography
Consciousness
cost
Costs
Diabetes
Diabetes mellitus
Diagnostic systems
Dizziness
Emergency medical care
Evaluation
Gait
Hospitals
Ischemia
Magnetic resonance imaging
Medical diagnosis
Medical imaging
Medical personnel
Neuroimaging
Neurology
NMR
Nuclear magnetic resonance
Patients
Physicians
Stroke
Vertigo
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Summary:Objectives: Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods: We retrospectively reviewed the records of 521 adult patients who visited the hospital during a 12-month period with dizziness as the chief complaint. Clinical findings were analyzed using Fisher's exact test to determine how they correlated with central neurological causes of dizziness identified by neuroimaging. Costs and diagnostic yields of neuroimaging were calculated. Results: Of the 521 patients, 1.5% had dizziness produced by central neurological causes. Gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings predicted central causes. Cases were associated with gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings . Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 42% and 9.5% of the examined cases, respectively, with diagnostic yields of 3.6% and 12%, respectively. Nine cases of dizziness were diagnosed from 269 brain scans, costing $607 914. Conclusion: Clinical evaluation can predict the presence of central neurological causes of dizziness, whereas neuroimaging is a costly and low-yield approach. Guidelines are needed for physicians, regarding the appropriateness of ordering neuroimaging studies. Abbreviations: OR: odds ratio; CI: confidence interval; ED: emergency department; CT: computed tomography; MRI: magnetic resonance imaging; HINTS: Head impulse, Nystagmus, Test of skew
ISSN:2000-9666
2000-9666
DOI:10.1080/20009666.2017.1332317