Introduction
Materials and methods
Study population and study design
Data extraction
Definitions and diagnoses
The management algorithm
Data analyses and statistics
Results
Study population and characteristics
Variable | Period 1 (n = 2126) | Period 2 (n = 1487) | Difference (95% CI) |
---|---|---|---|
Age, years, mean (SD) | 63.8 (18.9) | 62.6 (19.4) | – 1.2 (– 2.5 to 0.1) |
Female n (% of total) | 1209 (56.9) | 865 (58.2) | 1.3% (– 2.0 to 4.6%) |
Cardiovascular comorbidities, n (% of total) | |||
Hypertension | 1099 (51.7) | 729 (49.0) | – 2.7% (– 6.0 to 0.6%) |
Diabetes | 257 (12.1) | 173 (11.6) | – 0.5% (– 2.6 to 1.7%) |
Hyperlipidemia | 437 (20.6) | 234 (15.7) | – 4.8% (– 7.3 to – 2.3%) |
Congestive heart failure | 157 (7.4) | 66 (4.4) | – 3.0% (– 4.5 to – 1.4%) |
Atrial fibrillation | 290 (13.6) | 177 (11.9) | – 1.7% (– 3.9 to 0.5%) |
Previous TIA | 99 (4.7) | 64 (4.3) | – 0.4% (– 1.7 to 1.1%) |
Previous stroke | 231 (10.9) | 124 (8.3) | – 2.5% (– 4.4 to – 0.6%) |
Clinical characteristics (% of total) | |||
AVS | 408 (19.2) | 183 (12.3) | – 6.9% (– 9.2 to – 4.5%) |
Nystagmus | 223 (10.5) | 144 (9.7) | – 0.8% (– 2.8 to 1.2%) |
AVS with nystagmus (% within AVS) | 160 (39.2) | 112 (61.2) | 22.0% (13.3–30.2%) |
Focal neurological deficita (excl. Ataxia) | 76 (3.6) | 44 (3.0) | 0.6% (– 0.6 to 1.8%) |
Transient focal deficita | 64 (3.0) | 29 (2.0) | – 1.1% (– 2.1 to 0.0%) |
Ataxiaa | 76 (3.6) | 37 (2.5) | – 1.1% (– 2.2 to 0.1%) |
Any neurological deficita | 183 (8.6) | 97 (6.5) | – 2.1 (– 3.8 to 0.3%) |
Effectiveness markers and diagnoses
Outcome | Period 1 (n = 2126) | Period 2 (n = 1487) | Difference (95% CI) |
---|---|---|---|
(a) Symptom diagnoses, n (% of total) | 1174 (55.2) | 796 (53.5) | – 1.7% (– 5.0–1.6%) |
(b) Vestibular testing | |||
Dix–Hallpike tested, n (% of total) | 299/1437 (20.8)a | 560 (37.7) | 16.9% (13.6 to 20.1%) |
Referred to ENT, n (% of total) | 322 (15.2) | 279 (18.8) | 3.6% (1.1 to 6.2%) |
(c) Admittance | |||
Hospitalization, n (% of total) | 1308 (61.5) | 708 (47.6) | – 13.9% (– 10.6 to – 17.2%) |
Days spent in hospital, mean (SD)b | 3.85 (3.6) | 3.02 (3.4) | – 0.83 (– 1.15 to – 0.51) |
(d) Neuroradiology | |||
CT, n (% of total) | 891 (41.9) | 382 (25.7) | – 16.2% (– 19.2 to – 13.1%) |
MRI, n (% of total) | 209 (9.8) | 248 (16.7) | 6.9% (4.6–9.2%) |
Any neuroradiology, n (% of total) | 953 (44.8) | 539 (36.3) | – 8.6% (– 11.8 to – 5.3%) |
Patients undergoing both CT and MRI, n (% of total) | 147 (6.9) | 91 (6.1) | – 0.8% (– 2.4–0.9%) |
Diagnostic MRI, n (% of total)c | 30/209 (14.4) | 34/248 (13.7) | – 0.6% (– 7.2–5.7%) |
Diagnostic CT, n (% of total)c | 43/891 (4.8) | 36/382 (9.4) | 4.6% (1.6–8.2%) |
(e) 90-day outcomes | |||
ED Dizziness return visit within 90 days, n (% of total)d | 151 (8.1) | 83 (6.8) | – 1.3% (– 3.2–0.6%) |
Stroke-free within 90 days, n (% of total)e | 2119 (99.7) | 1480 (99.5) | – 0.1 (– 0.7–0.3) |
Category | Period 1 (n = 2126) | Period 2 (n = 1487) |
---|---|---|
Emergency department visitsa | $1,042,131 | $728,904 |
Neuroradiology | ||
CTb (total no. of scans) | $320,751 (891) | $137,516 (382) |
MRIc (total no. of scans) | $111,251 (209) | $132,011 (248) |
Total radiology | $432,002 | $269,527 |
Yearly radiology | $144,001 | $134,763 |
Radiology per visit | $203 | $181 |
Radiology per diagnostic scand | $5918 | $3850 |
Hospital caree | ||
Total costs for days in hospital (no. of days) | $3,970,432 (5041) | $1,690,249 (2146) |
Yearly costs | $1,985,216 | $845,125 |
Costs per visit | $1868 | $1137 |
Total costs | ||
Per year | $1,814,855 | $1,344,340 |
Per visit | $2561 | $1808 |