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Sharon H. Polensek, Claire E. Sterk, Ronald J. Tusa
Med Sci Monit 2008; 14(5): CR238-242
Dizziness and vertigo are very common patient complaints encountered by clinicians in both primary as well as specialty care in otolaryngology and neurology. Vestibular impairment is an underlying cause in as many as 45% of people complaining of dizziness. Most causes of vestibular impairment can be effectively treated; however, the diagnosis is frequently missed. The aim of this study was to examine clinical assessments used by providers in evaluating dizzy patients in outpatient clinics and the emergency department.
Material and Method: Computerized medical records of all patients receiving an ICD-9 diagnosis code for dizziness, including benign paroxysmal positional vertigo, Meniere's disease, and vestibular hypofunction over a six-month period at the Atlanta VA Medical Center were reviewed.
Results: 476 patients were identified and of these, 157 patients were included. Over two-thirds of providers (69%) used the patient's description of the dizziness for identifying the cause; however, significant variability was evident across disciplines, ranging from 84% of audiologists asking for a description of the dizziness to only 33% of geriatricians asking. 89% of providers did not evaluate a patient for BPPV by examining for positional nystagmus. Primary care clinicians referred 22% of dizzy patients to a specialist (neurotologist), geriatricians referred 17%, and emergency physicians referred only 16%.
Conclusions: Dizzy patients were not routinely screened for vestibular impairment based on available recommended practices, likely contributing to underdiagnosis and treatment. Results indicate a need for effective dissemination of guidelines to improve health care quality, increase awareness of medical risks, and enhance patient access to appropriate treatment.
Keywords: Vestibular Diseases - diagnosis, Vestibular Function Tests, Risk, Vertigo - diagnosis, Quality of Health Care, Primary Health Care - methods, Nystagmus, Physiologic, Meniere Disease - diagnosis, Medical Records Systems, Computerized, Diagnosis, Differential