Publication/Presentation Date

9-1-2013

Abstract

OBJECTIVES/HYPOTHESIS: To determine the usefulness and the costs of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of patients with dizziness in the emergency department (ED).

STUDY DESIGN: Retrospective chart review.

METHODS: Charts of patients with a specific health maintenance insurance plan presenting with dizziness and vertigo to a large health system's ED between January 2008 and January 2011 were reviewed. Patient demographics, signs/symptoms, and CT and MRI results were assessed. CT and MRI charges were determined based on positive versus unremarkable findings. Data analysis included stepwise logistic regressions.

RESULTS: Of 1681 patients identified, 810 (48%) received CT brain/head scan totaling $988,200 in charges. Of these, only 0.74% yielded clinically significant pathology requiring intervention. However, 12.2% of MRI studies yielded discovery of significant abnormalities. Logistic regression analysis revealed that older patients (P = .001) were more likely to receive a CT scan.

CONCLUSIONS: In the 3-year period studied, CT scans for ED patients with dizziness and vertigo yielded a low predictive value for significant pathology. These data reveal a great opportunity for cost savings by developing stricter guidelines for ordering CT scans for this set of ED patients. The use of MRI in all cases of dizziness was found to be neither practical nor useful. However, appropriately directed MRI of the brain is recommended in patients with dizziness and other neurological signs or symptoms.

Volume

123

Issue

9

First Page

2250

Last Page

2253

ISSN

1531-4995

Disciplines

Medicine and Health Sciences | Otolaryngology

PubMedID

23821602

Peer Reviewed for front end display

Peer-Reviewed

Department(s)

Department of Surgery, Department of Surgery Faculty

Document Type

Article

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