Nationwide resource utilization of dizziness/vertigo presentations to the ED

Abstract

Objective: This study aims to assess overall rates of neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]) and cerebrovascular accidents (CVAs) in patients presenting to the emergency department (ED) with primary diagnoses of dizziness/vertigo to determine if neuroimaging is overused in this population.

Study Design: Population-based ED registry analysis.

Setting: 2020 Nationwide Emergency Department Sample.

Patients: Patients presenting to the ED with dizziness/vertigo.

Interventions: Rates of neuroimaging (both CT and MRI), common associated diagnoses and symptoms, and CVAs.

Main Outcome Measures: Odds ratio (OR) and multivariate analysis were performed on the associations of common ED diagnoses with admission and CVAs.

Results 1,115,826 ED presentations received a primary diagnosis of vertigo/dizziness, resulting in $8.4 billion in ED charges. Of the patients discharged from the ED, 42.29% underwent neuroimaging. Overall, 2046 (0.18%) patients had a diagnosis of CVA. 89.46% of vertigo/dizziness patients with a CVA had at least one of 24 risk factors, including diabetes, history of thromboembolic event, nystagmus, and others, that were significantly associated with the presence of CVA in multivariate analysis. Current procedural terminology (CPT) codes of H81.2 (vestibular neuronitis) and H81.4 (vertigo of central origin) were significantly associated with CVA when compared to other forms of dizziness/vertigo (adjusted ORs of 3.26 and 3.98; p < 0.001).

Conclusions A high proportion of ED patients with vertigo/dizziness undergo neuroimaging to rule out CVA, while only 0.18% are diagnosed with CVA. 24 diagnoses are positively associated with CVAs in patients presenting with vertigo/dizziness and can decrease neuroimaging rates and lower healthcare costs.

Keywords

cerebrovascular accident / emergency department / healthcare utilization / vertigo

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