title: The use of neuroimaging studies and neurological consultation to evaluate dizzy patients in the emergency department.
abstract: OBJECTIVE
  Dizziness is a frequent reason for neuroimaging and neurological consultation, but little is known about the utility of either practice. We sought to characterize the patterns and yield of neuroimaging and neurological consultation for dizziness in the emergency department (ED).
  
  
  METHODS
  We retrospectively identified consecutive adults presenting to an academic ED from 2007 to 2009, with a primary complaint of dizziness, vertigo, or imbalance. Neurologists reviewed medical records to determine clinical characteristics, whether a neuroimaging study (head computed tomography [CT] or brain magnetic resonance imaging [MRI]) or neurology consultation was obtained in the ED, and to identify relevant findings on neuroimaging studies. Two neurologists assigned a final diagnosis for the cause of dizziness. Logistic regression was used to evaluate bivariate and multivariate predictors of neuroimaging and consultation.
  
  
  RESULTS
  Of 907 dizzy patients (mean age 59 years; 58% women), 321 (35%) had a neuroimaging study (28% CT, 11% MRI, and 4% both) and 180 (20%) had neurological consultation. Serious neurological disease was ultimately diagnosed in 13% of patients with neuroimaging and 21% of patients with neurological consultation, compared to 5% of the overall cohort. Headache and focal neurological deficits were associated with both neuroimaging and neurological consultation, while age ≥60 years and prior stroke predicted neuroimaging but not consultation, and positional symptoms predicted consultation but not neuroimaging.
  
  
  CONCLUSIONS
  In a tertiary care ED, neuroimaging and neurological consultation were frequently utilized to evaluate dizzy patients, and their diagnostic yield was substantial.
authors: Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY, USA.
authors: Babak B
authors: BB
authors: Navi
authors: Hooman
authors: H
authors: Kamel
authors: Maulik P
authors: MP
authors: Shah
authors: Aaron W
authors: AW
authors: Grossman
authors: Christine
authors: C
authors: Wong
authors: Sharon N
authors: SN
authors: Poisson
authors: William D
authors: WD
authors: Whetstone
authors: S Andrew
authors: SA
authors: Josephson
authors: S Claiborne
authors: SC
authors: Johnston
authors: Anthony S
authors: AS
authors: Kim
keywords: dizziness; emergency medicine; neuroimaging; referral and consultation; vertigo
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