Nathaniel von Fischer MD, Presenter: Nothing to Disclose

Achala Sameer Vagal MD, Abstract Co-Author: Nothing to Disclose

Rupa Radhakrishnan MBBS, Abstract Co-Author: Nothing to Disclose

Hing Yee Eng, Abstract Co-Author: Nothing to Disclose

The objective of our study was to analyze the use of CT angiogram (CTA) studies performed for an indication of vertigo/dizziness in the emergency department (ED) and explore the opportunity of potentially avoidable studies when evidence-based clinical criteria are applied before imaging.

All CTA head and neck studies performed in the ED of an academic, urban hospital between January 2005 and December 2010 on adult patients were analyzed. Radiology reports and clinical data were reviewed for patients evaluated with CTA for symptoms of vertigo/dizziness. Neurologic evaluation including findings such as nystagmus, gait imbalance, and otologic tests were recorded. Based on the CTA findings, the imaging results were categorized as negative/clinically irrelevant or positive/clinically relevant. We also noted which patients were admitted for further care and workup and which were discharged from the ED.

A total of 940 CTA head and neck studies were performed in the ED during the 6 year time period, of which 85 (9.0%) were for evaluation of vertigo/dizziness. None of the vertigo/dizziness patients had hearing loss and none were evaluated with emergent MRI. 79 out of 85 CTA studies for vertigo (92.9%) were negative and 6 (7.1%) were positive for vascular etiology. Neurological evaluation was a poor predictor of significant imaging findings. Out of the 79 negative CTA studies, 28 (35.4%) had positive neurological findings and 51 (64.6%) had normal examination. 3 patients out of the 6 positive CTA studies had an abnormal neurological examination. Pertaining to patient outcomes, 5 out of 6 patients (85.7%) with a positive CTA were admitted versus 25 out of 79 patients (31.6%) with a negative CTA were admitted (p-value < 0.01), suggesting imaging results may affect patient triage and disposition in the ED.

CTA for the emergent evaluation of vertigo/dizziness has low diagnostic yield and there is limited application of evidence-based clinical criteria for vascular imaging of the dizzy patient presenting to the ED.

Creating and implementing stronger clinical guidelines to increase the appropriate utilization of radiological studies is necessary, particularly given our limited healthcare resources.

von Fischer, N, Vagal, A, Radhakrishnan, R, Eng, H, Appropriateness of CT Angiogram in Emergency Department Patients Presenting with Vertigo/Dizziness.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043685.html