Practice variation in neuroimaging to evaluate dizziness in the ED

Area of Science:

• Emergency Medicine
• Neurology
• Radiology

Background:

• Guidelines and evidence are lacking on the appropriate use of neuroimaging for emergency department (ED) patients presenting with dizziness.
• Dizziness is a common chief complaint in EDs, necessitating evaluation to rule out serious conditions like stroke.

Purpose of the Study:

• To assess the variation in neuroimaging utilization (head CT and brain MRI) among EDs for patients with dizziness.
• To determine if higher rates of neuroimaging correlate with increased stroke diagnosis rates in this patient population.

Main Methods:

• A retrospective study analyzed data from 20 EDs within a large integrated health care program in 2008.
• Medical records were reviewed for adult patients with dizziness, capturing head computed tomography (CT) or brain magnetic resonance imaging (MRI) and stroke diagnoses within specified timeframes.
• Statistical models (random-effects logistic and linear regression) were used to analyze variations in neuroimaging use and its relationship with stroke diagnosis rates, adjusting for patient and site factors.

Main Results:

• Out of 20,795 patients with dizziness, 26.9% received a head CT and 3.1% had a brain MRI.
• Significant variation in head CT (21.8%-32.8%) and brain MRI (0.8%-6.2%) use was observed across sites, even after adjusting for patient and site characteristics.
• Higher rates of neuroimaging did not correspond to higher rates of stroke diagnosis, with stroke identified in 0.7%-2.5% of patients with dizziness by site.

Conclusions:

• Substantial variability exists in the application of neuroimaging for evaluating ED patients with dizziness.
• Current neuroimaging practices for dizziness do not appear to improve the detection of stroke, which is a rare diagnosis in this cohort.
• The findings underscore the need for evidence-based guidelines to standardize neuroimaging use in the ED evaluation of dizziness.