Value of Head CT Scan in the Emergency Department in Patients with Vertigo without Focal Neurological Abnormalities

Abstract

BACKGROUND:Vertigo is a common symptom and reason for admission to the emergency department (ED).AIM:This research aimed to determine the incidence of clinically significant findings on computed tomography (CT) in patients with vertigo without focal neurological abnormalities in the ED.MATERIAL AND METHODS:The results of the native CT scans in the ED were retrospectively analysed. Exclusion criteria included: focal neurological abnormalities, underlying malignancy, brain metastasis, previous brain operation, headache, fever, nausea, vomiting, head trauma, coagulopathy. As a clinically significant finding, we took into an account tumour, haemorrhage and acute ischemic lesion. 72 patients fulfilled the set criteria, present vertigo, without focal neurological abnormalities. Out of 72 patients with a median age of 62 (23-87) years old, 54% of the patients were female, and 46% were male.RESULTS:Normal CT findings were found in 44 patients (61.1%), 28 patients (38.9%) had pathological findings, out of that number 23 (31.9%) findings were clinically irrelevant and 5 (6.9%) were clinically significant. Out of the 5 clinically significant findings, tumour process was found in 3 (4.2%) patients, haemorrhage was found in 1 (1.4%) patient, and the ischemic lesion was found in 1 (1.4%) patient. Additional evaluation of five clinically significant findings showed a change of initial diagnosis in one case, but the significance of the finding remained the same.CONCLUSION:Our study demonstrates a low diagnostic yield of head CT examination with 6.9% of clinically significant findings in patients with vertigo without focal neurological abnormalities.

Benign paroxysmal positional vertigo in the emergency department: An observational study of an Australian regional hospital's acute clinical practice

“…Furthermore, failure to appreciate the limitations of acute CT imaging in the diagnosis of ischemic posterior fossa stroke is potentially hazardous 18 . Considering the low diagnostic yield of head CT (6.9%) for patients presenting with isolated vertigo absent of focal neurological changes, clinicians can experience cognitive error when falsely reassured by negative acute imaging 19 . This has the potential to lead to misdiagnosis and poorer patient outcomes.…”

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE‐3): Acute dizziness and vertigo in the emergency department

“…42 This low prevalence of stroke among all-comers with acute dizziness, coupled with the very low sensitivity of CT for ischemic stroke, underscores the limited diagnostic utility of CT for patients presenting with dizziness. 7,8,[43][44][45][46][47][48][49] Although CT is far more sensitive for intracerebral hemorrhage (ICH), ICH is an uncommon cause of patients presenting with isolated dizziness. 50 In this study of 595 ICH cases, only 13 (2.2%) presented with dizziness and a NIHSS of <2.…”

“…216,217 CT is associated with economic (cost), health (radiation exposure), and logistical (longer ED length of stay) harms without adding much value. 12,41,43,48 Our patient representatives highly valued accurate diagnosis (even for non-TIA diagnoses) based on preventable recurrence, ED visits, and earlier initiation of treatment.…”

Value of copeptin and S100B protein in the differential diagnosis of central vertigo and peripheral vertigo

“…In a study by Pavlović et al, CT imaging was not helpful in vertigo patients without focal neurological signs. 9 In patients who cannot be differentially diagnosed, MRI imaging is required, leading to extended length of stay in the emergency department and increased cost of diagnosis.…”