¿Qué aporta la neuroimagen en pacientes con vértigo y mareo? Análisis coste-utilidad

Martínez, Carmen Bécares; Lopez-Llames, A; Domingo, Marta M. Arroyo; Marco-Algarra, Jaime; Suárez-Varela, María Manuela Morales

doi:10.33588/rn.6808.2018399

Cited by 5 publications

(5 citation statements)

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“…According to the findings of this study, in 481 patients presenting to the ED with dizziness, 448 (93.1%) had unremarkable findings in brain CT scans. Our findings are comparable to previous studies that assessed the efficacy of routine brain imaging for patients with dizziness and concluded that it is of limited diagnostic value, time-consuming, and not as cost-effective [9,10,14,15]. As previously studied, CNS causes of dizziness are uncommon, comprising only 4%-6% of ED visits for dizziness [16].…”

Section: Discussionsupporting

confidence: 87%

The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study

Masood,

Alkhaja,

Alsetrawi

et al. 2024

Cureus

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Background: Dizziness is a common presenting complaint to emergency departments (ED) worldwide, with causes ranging from benign to life-threatening incidents. Computerized tomography (CT) of the brain remains a common diagnostic tool used by emergency physicians; however, it appears to be of low diagnostic value, especially in patients with normal neurological assessment while carrying multiple negative implications on both the patients and the healthcare systems. Our study aims to evaluate the diagnostic value of brain CT scans in assessing patients presenting to the ED with acute dizziness.Materials and methods: Retrospective review of medical records of patients presenting with complaints of dizziness to the ED at Salmaniya Medical Complex (SMC) who underwent a brain CT scan from January to June 2023. Collected data included patients' demographic information, presenting complaints, and CT scan results. A multivariable analysis of factors associated with positive CT scans was performed.Results: A total of 481 participants were enrolled in the study, representing diverse age groups as follows: 18-30 years (12.3%), 31-40 years (15.8%), 41-50 years (17.7%), 51-60 years (22.0%), and those aged over 60 years (32.2%). Among the participants, 56.3% identified as male and 43.7% as female. In terms of head trauma history, 7.1% of participants reported such incidents, while the majority (92.9%) had no history of head trauma. Exploring comorbidities, 43.5% of participants had at least one associated medical condition. Among the 481 study participants, brain CT scans revealed that the majority (93.1%) exhibited unremarkable results. The remaining cases exhibited acute events, including 5.4% with infarcts, 1.1% with hemorrhages, and 0.4% with space-occupying lesions. Conclusion:This study provides evidence of the limited value of brain CT scans in dizzy patients with unremarkable clinical examinations. As for clinicians, it can serve as a steppingstone toward the formulation of a policy and a set of guidelines for requesting brain CT scans in patients presenting to the ED with dizziness. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans in providing valuable findings.

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Section: Discussionsupporting

confidence: 87%

The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study

Masood,

Alkhaja,

Alsetrawi

et al. 2024

Cureus

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“…For instance, Becares-Martinez C et al reported that out of 493 cases, 286 imaging tests for vertigo cost 56,741 euros ($60,400), with a positive test amounting to 1,576 euros ($1,670). 21 Additionally, our study's proportion of patients undergoing neuroimaging (70.98%) surpasses figures from related research conducted in a Turkish emergency department (28%). 22 A systematic review which included studies from developed countries identified three main drivers of increased direct costs including excessive use of diagnostic imaging and excessive use of emergency care.15 In addition, the duration of hospitalization is also associated with an increase in cost, that is increase in the length of stay results in higher costs.…”

Section: Discussionmentioning

confidence: 49%

Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan

Baig,

Kapadia,

Raheem

et al. 2024

Pak J Med Sci

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Objective: To determine the frequency of neuro-imaging and the prevalence of positive findings in patients with vertigo visiting an emergency room of a low-middle-income-country, Pakistan. Methods: This is a retrospective cross-sectional study conducted in the emergency room of the Aga Khan University Hospital, a 550 bedded tertiary care teaching facility located in Karachi, Pakistan. The frequency of neuro-imaging in patients visiting emergency room with vertigo during 20 years (2000-2020), their findings and disposition was calculated in percentages. A cost-analysis was performed in Pakistani Rupees & US Dollars to estimate the financial burden. Results: During the emergency room visits for vertigo, neuro-imaging (CT scans, MRIs, or both) was conducted for 159 patients, accounting for 70.98% of the cases. Out of these, 64 individuals (40.25%) received a positive diagnosis, which included acute infarcts, hemorrhages, metastases, space-occupying lesions, and meningeal enhancements. Interestingly, among those with negative findings, the 98 patients faced significantly higher costs, amounting to Rs.4,108,000 ($22,449), in contrast to the positive cases, which incurred Rs.2,496,600 ($13,642). Conclusion: The frequency of obtaining neuro-imaging tests in patients with vertigo were significantly high in our study. In addition, there was a significant financial burden associated with neuro-imaging especially for our low-middle-income country. doi: https://doi.org/10.12669/pjms.40.4.7029 How to cite this: Baig MNA, Kapadia N, Raheem A, Ismail M. Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2024;40(4):582-588. doi: https://doi.org/10.12669/pjms.40.4.7029 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…5 Similarly, Becares-Martinez et al reported an imaging costs of €56 741 which of more than 90% was not even related to vertigo in 493 patients. 6 Similarly, Kerber et al reported a median of 3.6 tests (laboratory or imaging) at each ED visit for vertigo-dizziness between 1995 through 2004. Researchers also highlighted a gradually increased (169%) tests utilization in time.…”

Section: Discussionmentioning

confidence: 97%

“…Seeking medical care due to the symptoms of vertigo associated with higher costs in recent studies. 5,6 Researches also suggested that vertigo has significant impact on work productivity, such that severe vertigo symptoms may lead patients to quit or change their jobs. 7 As vertigo more frequently occurs in elderly population, hospitalized patients increase gradually in aging populations.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, hospitalization costs increase substantially with increasing number of the hospitalized patients. 6,7 On the other hand, vertigo has significant health-care costs that includes charges of the medications, laboratory, and imaging tests. 5,7 Moreover, varied health-care costs between hospitalized and outpatients with dizziness also documented.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients

et al. 2020

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Objective: Vertigo and dizziness are the common presenting concerns in emergency departments and outpatient clinics, accounts for approximately 15% to 20% of adults annually. We aimed to evaluate economic burden of vertigo on health-care system and work productivity in association between clinic characteristics of in- or outpatients. Methods: A total number of 2289 patients diagnosed with peripheric (noncentral) vertigo were evaluated retrospectively. The direct medical costs associated with vertigo classified as medication, consumable, imaging, and laboratory. In addition, the indirect costs were associated with lost working days. The overall economic impact of vertigo assessed via total expenditure for diagnosis and treatment. Results: The mean duration of hospitalization was 5.6 ± 4.3 days and working day lost was 9.47 ± 3.90 days. The overall impact on work productivity of disease was 15.35 ± 6.11 days. The overall mean direct cost including all expenditure items associated with vertigo care was $250.25 ± $1479.62 per patient. The overall cost associated with vertigo was found to be statistically increased in the male, aged ≥65 years, widow or divorced, and hospitalized patients. Conclusions: Our findings clearly indicate that a vertigo–dizziness management program based on patients’ risk factors may achieve to reduce hospitalizations and cost of hospital care as well.

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¿Qué aporta la neuroimagen en pacientes con vértigo y mareo? Análisis coste-utilidad

Cited by 5 publications

References 0 publications

The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study

The Diagnostic Value of Brain CT Scans in Evaluating Dizziness in the Emergency Department: A Retrospective Study

Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan

The Economic Burden of Vertigo: Results From the Hospitalized and Outpatients

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