Spectrum of dizziness visits to US emergency departments: Cross-sectional analysis from a nationally representative sample

David E. Newman-Toker, Yu Hsiang Hsieh, Carlos A. Camargo, Andrea J. Pelletier, Gregary T. Butchy, Jonathan A. Edlow

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To describe the spectrum of visits to US emergency departments (EDs) for acute dizziness and determine whether ED patients with dizziness are diagnosed as having a range of benign and dangerous medical disorders, rather than predominantly vestibular ones. PATIENTS AND METHODS: A cross-sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) used a weighted sample of US ED visits (1993-2005) to measure patient and hospital demographics, ED diagnoses, and resource use in cases vs controls without dizziness. Dizziness in patients 16 years or older was defined as an NHAMCS reason-for-visit code of dizziness/vertigo (1225.0) or a final International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of dizziness/vertigo (780.4) or of a vestibular disorder (386.x). RESULTS: A total of 9472 dizziness cases (3.3% of visits) were sampled over 13 years (weighted 33.6 million). Top diagnostic groups were otologic/vestibular (32.9%), cardiovascular (21.1%), respiratory (11.5%), neurologic (11.2%, including 4% cerebrovascular), metabolic (11.0%), injury/poisoning (10.6%), psychiatric (7.2%), digestive (7.0%), genitourinary (5.1%), and infectious (2.9%). Nearly half of the cases (49.2%) were given a medical diagnosis, and 22.1% were given only a symptom diagnosis. Pre-defined dangerous disorders were diagnosed in 15%, especially among those older than 50 years (20.9% vs 9.3%; P<.001). Dizziness cases were evaluated longer (mean 4.0 vs 3.4 hours), imaged disproportionately (18.0% vs 6.9% undergoing computed tomography or magnetic resonance imaging), and admitted more often (18.8% vs 14.8%) (all P<.001). CONCLUSION: Dizziness is not attributed to a vestibular disorder in most ED cases and often is associated with cardiovascular or other medical causes, including dangerous ones. Resource use is substantial, yet many patients remain undiagnosed.

Original languageEnglish (US)
Pages (from-to)765-775
Number of pages11
JournalMayo Clinic proceedings
Volume83
Issue number7
DOIs
StatePublished - Jul 2008

ASJC Scopus subject areas

  • Medicine(all)

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