Acute dizziness - resource use and diagnosis with targeted clinical examination

Acute dizziness often leads to hospital admission because of suspected stroke. A targeted clinical examination comprising positional tests and assessment of gaze stability, nystagmus and vertical ocular misalignment is a well-documented tool for distinguishing between central and peripheral causes. The purpose of the study was to investigate whether implementation of a treatment algorithm incorporating a targeted clinical examination for acute dizziness was associated with changes in resource use, shorter hospital stays and improved diagnostic accuracy.

A retrospective analysis was conducted of all patients admitted to the Department of Neurology at Akershus University Hospital in Norway between 2015 and 2023. The study period was divided into three periods: before (2015-17), during (2018-20) and after (2021-23) implementation of the treatment algorithm. Comparisons were made of brain CT and MRI, assessment by an otolaryngologist, length of hospital stay, and the proportion of patients discharged with a specific diagnosis of dizziness before and after implementation of the algorithm.

Among patients discharged with dizziness as the primary diagnosis, there was a significant increase in the proportion undergoing CT (from 87.5% to 90.9%), while the use of MRI decreased significantly (from 34.7% to 24.5%). Assessment by an otolaryngologist decreased significantly (from 21.5% to 6.8%). There was a small, non-significant reduction in length of hospital stay, in contrast to a statistically significant increase in length of stay in the reference group. The proportion of patients discharged with a specific diagnosis of dizziness increased from 20% in the period before implementation to 34% in the period after implementation.

Implementation of a treatment algorithm incorporating a targeted clinical examination for acute dizziness in a neurology department was associated with reduced resource use (apart from a small increase in the use of CT) and improved diagnostic accuracy.