Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin

Abstract

Background: Vestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations. Methods: This retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was 'vestibular symptoms'. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis. Results: A total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians' work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging. Conclusion: One in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.

What is the current status of care by neuro-otology specialists in Switzerland—A national survey

“…In contrast, in the ED of a large Swiss academic hospital, with the availability of neurologists and ENT physicians 24/7, substantial fractions of dizzy patients were seen by a neurologist (35.3%) or an ENT physician (11.4%). The resulting rate of vestibular symptoms of unknown origin (14.3%) was below the fraction (20–30%) previously reported ( 12 ). This emphasizes the importance of triage and the value of multiple specialized assessments in selected cases with acute dizziness.…”

Vestibular syndromes, diagnosis and diagnostic errors in patients with dizziness presenting to the emergency department: a cross-sectional study

“…The current clinical approach leads to an unnecessary overuse of CT and MRI and increases costs exceeding billions of dollars in the US alone. 39 Patients with dizziness have longer average ED stays than patients without dizziness because they undergo more testing. 16 The rate of undiagnosed or misclassified patients remains high, resulting in higher costs and considerable waste of resources in the ED in Switzerland.…”

“…CT scans, however, are only suggested in patients with suspected trauma, haemorrhage or in patients with a contraindication for an MRI. The current clinical approach leads to an unnecessary overuse of CT and MRI and increases costs exceeding billions of dollars in the US alone 39. Patients with dizziness have longer average ED stays than patients without dizziness because they undergo more testing 16.…”

“…Patients with dizziness have longer average ED stays than patients without dizziness because they undergo more testing 16. The rate of undiagnosed or misclassified patients remains high, resulting in higher costs and considerable waste of resources in the ED in Switzerland 39–41. Furthermore, the overuse of CT and MRI may decrease the access for other patients and it can increase the exposition to an unnecessary amount of radiation.…”

Vestibular Deficits in Deafness: Clinical Presentation, Animal Modeling, and Treatment Solutions

“…Vestibular dysfunction leads to one of the most common complaints in medicine, dizziness and/or vertigo, which affects 15–35% of the general population ( 8 – 11 ). In Europe, vestibular disorders of peripheral origin account for 3% of all medical consultations for patients over the age of 50 years and about 1% of the emergency cases seen at hospitals ( 12 , 13 ). National questionnaires have estimated that the prevalence of dizziness/vertigo in children (3 years of age to adolescence) ranges from 5.3 to 8% ( 14 , 15 ).…”