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APHA Scientific Session and Event Listing

Sharon S. Hartman, MD, PhD, Rehabilitation Research and Development, Atlanta VA Medical Center, 1670 Clairmont Road, Room 12C-119, Decatur, GA 30033-4004, 404-321-6111, ext. 2239, sshartm@emory.edu, Claire E. Sterk, PhD, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, and Ronald J. Tusa, MD, PhD, Neurology, Emory University, 1441 Clifton Road NE, Room 239, Atlanta, GA 30322.

Approximately 90 million adult Americans (42% of the U.S. population) have experienced dizziness. For patients over 75, dizziness is the most common reason to visit a physician. Although a vestibular problem is an underlying cause in as many as 45% of people complaining of dizziness, many patients may not receive appropriate treatment for vestibular impairment (VI) since the diagnosis is frequently missed. Benign paroxysmal positional vertigo (BPPV) is the most common cause for vertigo and is frequently not identified despite the gold standard test for diagnosis, the Dix-Hallpike maneuver, being easily performable during an office visit. Similarly, vestibular loss may be swiftly identified with a head thrust test. OBJECTIVE: The primary aim of this study was to determine the evaluation and referral practices of clinicians when caring for patients presenting with complaints of dizziness with possible VI. A secondary objective was to examine the association of certain provider characteristics with recommended evaluation practices. METHODS: A retrospective review was performed on computerized medical records of all patients receiving a new ICD-9 diagnosis code for dizziness, BPPV, or other form of VI between July 1 and December 31, 2004, in the Atlanta VA Medical Center. A patient visit was excluded from analysis if identified as a post-hospitalization visit, if the provider was a neurotologist, if a non-vestibular cause for the symptoms was determined (e.g., orthostatic hypotension), the patient was subsequently referred outside of the facility, or if the work up remained incomplete as of June 30, 2005. RESULTS: A total of 476 patients were identified as receiving an ICD-9 code for dizziness or some form of VI. Of these, 157 patients met inclusion criteria for analysis. Over two-thirds (69%) of all providers obtained the description of the dizziness to assist in identifying the etiology; however, significant variability was evident across disciplines, ranging from 84% of audiologists asking for a description of dizziness to 33% of geriatricians obtaining this information. The majority of providers (89%) did not assess a patient for possible BPPV by looking for positional nystagmus. Referrals to specialists were made for only 22% and 17% of patients by primary care physicians and geriatricians, respectively. Emergency physicians referred only 16% of dizzy patients. CONCLUSIONS: Medical evaluation of dizzy patients fell short of recommended practices. These results indicate a need for educational efforts to increase awareness of medical risks and for learning recommended methods of evaluation for patients with possible VI.

Learning Objectives: At the conclusion of the session, the participant (learner) will be able to

• Appreciate the need for medical providers to better understand and follow recommended practices in the evaluation and approach to dizzy patients who could have VI
• Describe current common evaluation and referral practices of clinicians when caring for patients presenting with complaints of dizziness with possible VI.
• Identify pertinent associations between provider specialty and recommended evaluation practices.

Keywords: Evaluation, Physicians

Presenting author's disclosure statement:

Not Answered