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This study aims to evaluate whether a management algorithm has improved the effectiveness of care for dizzy patients at Umeå University Hospital.
This was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012–2014) and after (period 2, 2016–2017) the implementation of a management algorithm. Outcomes were changes in a set of pre-defined effectiveness markers and health economic effects.
Total n = 2126 and n = 1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix–Hallpike testing increased, 20.8% [95% confidence interval (CI) 18.8–23.0%] vs. 37.7% (95% CI 35.2–40.2%), as did BPPV diagnoses, 7.6% (95% CI 6.6–8.8%) vs. 15.3% (95% CI 13.6–17.3%). Hospitalization became less common, 61.5% (95% CI 59.4–63.6%) vs. 47.6% (95% CI 45.1–50.2%). The proportion undergoing any neuroradiological investigation decreased, 44.8% (95% CI 42.7–47.0%) vs. 36.3% (95% CI 33.8–38.7%) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.
This study shows that the implementation of a management algorithm for dizzy patients was associated with improved effectiveness of care.
Bisdorff A, Von Brevern M, Lempert T, Newman-Toker DE (2009) Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res 19(1–2):1–13. https://doi.org/10.3233/VES-2009-0343
Kerber KA, Meurer WJ, West BT, Fendrick AM (2008) Dizziness presentations in US emergency departments, 1995–2004. Acad Emerg Med 15(8):744–750. https://doi.org/10.1111/j.1553-2712.2008.00189.x CrossRef
Kerber AK, Brown LD, Lisabeth DL, Smith AM, Morgenstern BL (2006) Stroke Among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 37(10):2484–2487. https://doi.org/10.1161/01.STR.0000240329.48263.0d CrossRef
Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, Whetstone WD, Josephson SA, Johnston SC, Kim AS (2012) Rate and Predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc 87(11):1080–1088. https://doi.org/10.1016/j.mayocp.2012.05.023 CrossRef
Marmol-Szombathy I, Dominguez-Duran E, Calero-Ramos L, Sanchez-Gomez S (2018) Identification of dizzy patients who will develop an acute cerebrovascular syndrome: a descriptive study among emergency department patients. Eur Arch Otorhinolaryngol 275(7):1709–1713. https://doi.org/10.1007/s00405-018-4988-2 CrossRef
Predicare web page. https://predicare.se. Accessed 30th November 2018
Kerber KA, Meurer WJ, Brown DL, Burke JF, Hofer TP, Tsodikov A, Hoeffner EG, Fendrick AM, Adelman EE, Morgenstern LB (2015) Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study. Neurology 85(21):1869–1878. https://doi.org/10.1212/WNL.0000000000002141 CrossRef
Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (2009) HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40(11):3504–3510. https://doi.org/10.1161/STROKEAHA.109.551234 CrossRef
Kerber KA, Burke JF, Skolarus LE, Meurer WJ, Callaghan BC, Brown DL, Lisabeth LD, McLaughlin TJ, Fendrick AM, Morgenstern LB (2013) Use of BPPV processes in emergency department dizziness presentations: a population-based study. Otolaryngol Head Neck Surg 148(3):425–430. https://doi.org/10.1177/0194599812471633 CrossRef
Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S (2007) Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. The Lancet 369(9558):293–298. https://doi.org/10.1016/S0140-6736(07)60151-2 CrossRef
Kerber KA, Zahuranec DB, Brown DL, Meurer WJ, Burke JF, Smith MA, Lisabeth LD, Fendrick AM, McLaughlin T, Morgenstern LB (2014) Stroke risk after nonstroke emergency department dizziness presentations: a population-based cohort study. Ann Neurol 75(6):899. https://doi.org/10.1002/ana.24172 CrossRef
- Effectiveness of care in acute dizziness presentations
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