Analysis of Imaging for Patients Presenting to Emergency Department with Nonspecific Dizziness

Introduction: Excessive imaging in patients with nonspecific dizziness is costly and may delay timely diagnosis. This study aims to describe characteristics of dizzy patients undergoing brain imaging in the emergency department (ED) who were later evaluated by otolaryngology.

Methods: All patients presenting to the ED at an academic referral center with dizziness between January 2016 and June 2024 were identified. Patient demographics, including age at presentation and comorbidity scores, were captured. Diagnostic neuroimaging at initial ED visit, subsequent otolaryngology referrals, and final diagnosis were recorded. Stratified analyses were performed.

Results: Overall, 63,704 patients were included, with 39,428 (61.9%) females and a median age of 49.5 years (IQR 31.5, 66.2). Imaging was acquired for 12,233 (19.2%) patients. MRI brain without contrast was most performed (2,162, 17.7%), followed by CT head and neck angiogram with and without contrast (1,105, 9.0%). Significant differences in age (p < 0.001), smoking status (p = 0.045), inpatient admission (p < 0.001), and insurance type (p < 0.001) were found between patients who did and did not receive imaging.

Outpatient evaluation by an otolaryngologist was sought by 2,272 (3.6%), and was more common in patients who were older, never/former smokers, on private insurance, those not requiring admission, and those who received imaging (all p< 0.001). Patients who required imaging had a longer median time to outpatient otolaryngology evaluation (73.0 weeks (IQR 10.4, 177.7), compared to 15.6 weeks (IQR 5.2, 88.6)) in patients without imaging. The most common diagnoses for patients seen by otolaryngology were benign positional vertigo (10.0%), migraine (4.3%), Ménière’s disease (2.7%), and vestibular schwannoma (1.4%).

Conclusions: Dizzy patients presenting to the ED who underwent imaging were more likely to be seen by otolaryngology, although imaging significantly delayed time to outpatient evaluation. Improved clinical decision-making and education on appropriate imaging practices is essential for enhancing patient care and resource efficiency.