Value of Head CT Scan in the Emergency Department in Patients with Vertigo without Focal Neurological Abnormalities
DOI:
https://doi.org/10.3889/oamjms.2018.340Keywords:
Key words, vertigo, emergency department, computed tomography (CT)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.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope. 2013; 123(9):2250-3. https://doi.org/10.1002/lary.23798 PMid:23821602
Newman-Toker DE, Hsieh YH, Camargo CA, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008; 83(7):765-75. https://doi.org/10.4065/83.7.765 PMid:18613993 PMCid:PMC3536475
Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA, et al. Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care. Ann Intern Med. 1992; 117(11):898-904. https://doi.org/10.7326/0003-4819-117-11-898 PMid:1443950
Hanley K, O'Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract. 2001; 51(469):666-71. PMid:11510399 PMCid:PMC1314080
Cappello M, di Blasi U, di Piazza L, Ducato G, Ferrara A, Franco S, et al. Dizziness and vertigo in a department of emergency medicine. Eur J Emerg Med. 1995; 2(4):201-11. https://doi.org/10.1097/00063110-199512000-00006 PMid:9422208
Stewart MG, Chen AY, Wyatt JR, Favrot S, Beinart S, Coker NJ, et al. Cost-effectiveness of the diagnostic evaluation of vertigo. Laryngoscope. 1999; 109(4):600-5. https://doi.org/10.1097/00005537-199904000-00015 PMid:10201748
Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006; 37(10):2484-7. https://doi.org/10.1161/01.STR.0000240329.48263.0d PMid:16946161 PMCid:PMC1779945
Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. Acad Emerg Med. 2008; 15(8):744-50. https://doi.org/10.1111/j.1553-2712.2008.00189.x PMid:18638027
Smith-Bindman R, Miglioretti DL, Larson EB. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood). 2008; 27(6):1491-502. https://doi.org/10.1377/hlthaff.27.6.1491 PMid:18997204 PMCid:PMC2765780
Wasay M, Dubey N, Bakshi R. Dizziness and yield of emergency head CT scan: Is it cost effective? Emergency Medicine Journal. 2005; 22(4):312. https://doi.org/10.1136/emj.2003.012765 PMid:15788853 PMCid:PMC1726733
Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369(9558):293-8. https://doi.org/10.1016/S0140-6736(07)60151-2
Simmons Z, Biller J, Adams HP, Dunn V, Jacoby CG. Cerebellar infarction: comparison of computed tomography and magnetic resonance imaging. Ann Neurol. 1986; 19(3):291-3. https://doi.org/10.1002/ana.410190312 PMid:3963774
Bruzzone MG, Grisoli M, De Simone T, Regna-Gladin C. Neuroradiological features of vertigo. Neurological Sciences. 2004; 25:S20-S3. https://doi.org/10.1007/s10072-004-0211-x PMid:15045615
Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010; 363(1):1-4. https://doi.org/10.1056/NEJMp1002530 PMid:20573919
Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007; 14(1):63-8. https://doi.org/10.1197/j.aem.2006.06.060 PMid:17200515
Burt CW, Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1999--2000. Vital and health statistics. Series 13, Data from the National Health Survey. 2004; (157):1-70.
Goyal N, Donnino MW, Vachhani R, Bajwa R, Ahmad T, Otero R. The utility of head computed tomography in the emergency department evaluation of syncope. Internal and Emergency Medicine. 2006; 1(2):148-50. https://doi.org/10.1007/BF02936543 PMid:17111790
Mitsunaga MM, Yoon HC. JOURNAL CLUB: Head CT Scans in the Emergency Department for Syncope and Dizziness. American Journal of Roentgenology. 2015; 204(1):24-8. https://doi.org/10.2214/AJR.14.12993 PMid:25539233
Lawhn-Heath C, Buckle C, Christoforidis G, Straus C. Utility of head CT in the evaluation of vertigo/dizziness in the emergency department. Emerg Radiol. 2013; 20(1):45-9. https://doi.org/10.1007/s10140-012-1071-y PMid:22940762
Fakhran S, Alhilali L, Branstetter BF. Yield of CT angiography and contrast-enhanced MR imaging in patients with dizziness. AJNR Am J Neuroradiol. 2013; 34(5):1077-81. https://doi.org/10.3174/ajnr.A3325 PMid:23099499
Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, et al. The use of neuroimaging studies and neurological consultation to evaluate dizzy patients in the emergency department. Neurohospitalist. 2013; 3(1):7-14. https://doi.org/10.1177/1941874412458677 PMid:23983882 PMCid:PMC3726125
Grossman SA, Fischer C, Bar JL, Lipsitz LA, Mottley L, Sands K, et al. The yield of head CT in syncope: a pilot study. Intern Emerg Med. 2007;2(1):46-9. https://doi.org/10.1007/s11739-007-0010-5 PMid:17551685 PMCid:PMC2780634
Chase M, Joyce NR, Carney E, Salciccioli JD, Vinton D, Donnino MW, et al. ED patients with vertigo: can we identify clinical factors associated with acute stroke? Am J Emerg Med. 2012; 30(4):587-91. https://doi.org/10.1016/j.ajem.2011.02.002 PMid:21524878
Kim AS, Sidney S, Klingman JG, Johnston SC. Practice variation in neuroimaging to evaluate dizziness in the ED. Am J Emerg Med. 2012; 30(5):665-72. https://doi.org/10.1016/j.ajem.2011.02.038 PMid:21570240 PMCid:PMC4560264
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0
