Practice variation in neuroimaging to evaluate dizziness in the ED - 05/06/12
, Stephen Sidney, MD, MPH d, Jeffrey G. Klingman, MD c, S. Claiborne Johnston, MD, PhD a, bAbstract |
Background |
The appropriate role of neuroimaging to evaluate emergency department (ED) patients with dizziness is not established by guidelines or evidence.
Methods |
We identified all adults with a triage complaint of dizziness who were evaluated at 20 EDs of a large Northern California integrated health care program in 2008. Using comprehensive medical records, we captured all head computed tomographies (CTs) or brain magnetic resonance images (MRIs) completed at presentation or within 2 days and all stroke diagnoses within 1 week. We assessed variation in neuroimaging use by site using a random-effects logistic model to account for differences in patient- (demographic and vascular risk factors) and site-level factors (volume, % patients with dizziness, and % patients with dizziness admitted) and linear regression to assess the relationship between neuroimaging rates and stroke diagnosis rates by site.
Results |
Of 378 992 patients seen in 2008, 20 795 (5.5%) had at least one ED visit for dizziness. Overall, 5585 patients (26.9%) had a head CT and 652 (3.1%) had a brain MRI. Between 21.8% and 32.8% of ED patients with dizziness at each site had a head CT (P < .001). For brain MRI, the range was 0.8% to 6.2%—a nearly 8-fold variation (P < .001) that persisted after adjustment for patient- and site-level factors. Higher neuroimaging rates did not translate into higher stroke diagnoses rates, with 0.7% to 2.5% of patients with dizziness diagnosed with stroke by site.
Conclusion |
The use of neuroimaging for ED patients with dizziness varies substantially without an associated improvement in stroke diagnosis, which is identified only rarely.
Le texte complet de cet article est disponible en PDF.Plan
| ☆ | This project was supported by an award from the American Heart Association (0875020N) and by National Institutes of Health/National Center for Research Resources/University of California San Francisco-Clinical and Translational Sciences Institute grant no. KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the American Health Association or the National Institutes of Health. |
| ☆☆ | Presented in abstract form at the International Stroke Conference, Los Angeles, Calif, February 2011. |
Vol 30 - N° 5
P. 665-672 - juin 2012 Retour au numéro
Article précédent
- Hospital burden of unintentional carbon monoxide poisoning in the United States, 2007
- Shahed Iqbal, Huay-Zong Law, Jacquelyn H. Clower, Fuyuen Y. Yip, Anne Elixhauser
- External validation of the Glasgow-Blatchford Bleeding Score and the Rockall Score in the US setting
- Subhash Chandra, Erik P. Hess, Dipti Agarwal, David M. Nestler, Victor M. Montori, Louis M. Wong Kee Song, George A. Wells, Ian G. Stiell
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?