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Dizziness and yield of emergency head CT scan: Is it cost effective?
  1. M Wasay1,*,
  2. N Dubey2,
  3. R Bakshi2
  1. 1Department of Neurology, The Aga Khan University, Karachi, Pakistan
  2. 2Department of Neurology, Buffalo Neuroimaging Analysis Center, University at Buffalo, State University of New York, Buffalo, NY, USA
  1. Correspondence to:
 Mohammad Wasay MD
 Department of Neurology, The Aga Khan university, Stadium Road, Karachi 74800, Pakistan; mohammad.wasayaku.edu

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Dizziness is a common cause of emergency room (ER) visits.1 The yield of various diagnostic tests in patients with dizziness has been evaluated in outpatient or ambulatory care settings but no data are available regarding cost effectiveness of CT in these patients. We prospectively evaluated the diagnostic yield of head CT in the evaluation of dizziness presenting in an ER setting.

All consecutive patients with a chief complaint of acute dizziness or vertigo in the ER, who underwent head CT were enrolled in study (n = 344) at two hospitals (Millard Fillmore Gates Circle Hospital and Millard Fillmore Suburban Hospital, Buffalo, NY) from September 1998 to July 1999. Vertigo was defined as sense of self rotation or environmental spin while dizziness was defined as sensation of unsteadiness or imbalance without rotation. Patients were excluded for a history of head and neck trauma, headache, altered mental status, recent head and neck surgery, or a new onset focal neurological deficit (n = 144). A total of 200 patients were included in the study.

Of the 200 patients included in the study, 79 (40%) were men. Age range was 10–93 years (mean 68 years). CT showed normal findings (n = 105; 52%), diffuse brain atrophy (n = 27; 13%), non-specific periventricular white matter changes (n = 42; 21%), chronic large vessel distribution infarction (n = 21; 10%), chronic lacunar infarction (n = 31; 15%), chronic brain stem or cerebellar infarction (n = 8; 4%), chronic subdural fluid collections (n = 6; 3%), chronic post operative changes (n = 5; 3%), chronic watershed infarction (n = 1) and the presence of a ventriculoperitoneal shunt (n = 1). No acute abnormalities including infarction, hemorrhage, hydrocephalus, mass effect, or midline shift were identified. No scan showed a lesion that could explain patient’s symptoms of dizziness or vertigo. The average reimbursement for a non-contrast CT scan of the head was $300 during this time; thus the expense for the total cost was approximately $60,000 and the diagnostic yield for the evaluation of dizziness was zero.

Up to 30% of people over the age of 65 complain of dizziness.2 It is a common cause of ER visits in the USA. Studies have shown that the majority of these patients have peripheral vestibular dysfunction.3 We conclude that incidence of acute intracranial lesions on head CT scan is extremely low in patients with dizziness with a normal neurological examination and no other significant neurological symptoms. The diagnostic yield of emergency head CT is low among these patients and does not appear to be cost effective.

Acknowledgments

This study was presented in preliminary form at the American College of Emergency Physician’s research forum, Las Vegas, NV in October 1999. This study was supported in part by research grants to R Bakshi from the National Institutes of Health (NIH-NINDS 1 K23 NS42379-01) and National Science Foundation (DBI-0234895).

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Footnotes

  • * Current affiliation: Center for Neurological Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

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