strength in numbers: dizziness

23 Apr

Cribbed from this March ACEP Now article:

 

DIZZINESS/VERTIGO: numbers to consider

clinical factors associated with stroke in vertiginous patients

  • gait instability: Odds Ratio (OR) 9.3
  • subtle neurological findings: OR 8.7

 

predictors for serious neurological disease with complaint of dizziness, vertigo, or imbalance

  • Focal neurological abnormalities: OR 5.9
  • 60 years of age or older: OR 5.7
  • Imbalance: OR 5.9
  • Isolated dizziness: OR 0.20  (i.e. 80% less likely to be experiencing a serious neurological cause)

 

Study of 1681 pts w/dizziness:

  • CTs obtained in 48%
  • MRI’s in 5%

 

  • cost associated with identifying one abnormal CT: $165k
  • cost associated with identifying one abnormal MRI: $22k
  • all patients with positive CT or MRI had headache, neuro findings on exam, or optho complaints

 

5-SECOND TAKEAWAY:

  • don’t skimp on the neuro exam
  • walk (gait test) your dizzy patients

 

References: ACEP Now Article; picture

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