Performing computed tomography (CT) scanning in the emergency room (ER) for patients experiencing dizziness may not be worth the cost--a key finding now that clinicians are searching for ways to reduce costs without sacrificing patient care.

According to the study, conducted by investigators from the Henry Ford Hospital (Detroit, MI, USA), less than 1% of the CT scans performed in the ER revealed a more serious underlying cause for dizziness--intracranial bleeding or stroke--that required intervention.

The findings suggest that it may be more cost effective for hospitals to implement stricter guidelines for ordering in-emergency department CT scans of the brain and head for patients experiencing dizziness. “When a patient comes into the emergency department experiencing dizziness, a physician's first line of defense is often to order a CT scan to rule out more serious medical conditions. But in our experience it is extremely rare that brain and head imagining yields significant results,” said study author Syed F. Ahsan, MD, a neurootologist in the department of otolaryngology-head and neck surgery at Henry Ford. “It is our hope that our investigation into our own practices will shed light on avenues to run leaner practices within our institution, as well as serve as a model for other health systems.”

The study was presented in January 2012 in Miami Beach (FL, USA), at the annual Triological Society’s Combined Sections meeting.

The Henry Ford study was a retrospective review of 1,681 patients with dizziness or vertigo who came into a Detroit metropolitan emergency department between January 2008 and January 2011. Of those patients, almost half (810 patients) received a CT scan of the brain and head, but only 0.74% of those scans yielded clinically significant results that required intervention. In all, the total cost for the CT scans during the three-year period was USD 988,200. The analysis also revealed that older patients and those with a lower income were more likely to receive a CT scan for dizziness when they came into the emergency department.

Whereas dizziness may be a sign of intracranial bleeding or stroke, it is more likely that the cause is due to dehydration, anemia, a decrease in blood pressure with standing (orthostatic hypotension) problems, or inflammation in the inner ear such as benign paroxysmal positional vertigo, labyrinthitis, or Meniere’s disease, or vestibular neuritis.

Moreover, Dr. Ahsan noted, in earlier research it has been well documented that CT scans are not very effective in detecting stroke or intracranial bleeding in the acute (emergency room) setting.

Ultimately, the study demonstrated that there is potential for cost savings by creating and implementing stronger guidelines to determine when it is medically necessary for patients with dizziness to undergo CT imaging in the emergency department.

 

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