Study: CT For ED Dizziness Almost Never Helps

Less than 1 percent of the time—0.74 percent, to be precise—does a CT scan performed on an emergency department patient who is experiencing dizziness yield clinically significant results that require medical intervention.

So says a study by researchers at Henry Ford Hospital in Detroit. They presented it this week at The Triological Society’s annual Combined Sections Meeting in Miami Beach, Florida.

The study retrospectively reviewed the cases of 1,681 patients with dizziness or vertigo who visited a Detroit metropolitan emergency department during the period of January 2008 through January 2011. Of those, 810 received a CT scan of the brain and head, at a total cost over the three years of $988,200. Only 0.74 percent of the scans found anything that required intervention, such as intracranial bleeding or stroke.

Study author Syed F. Ahsan, MD, said:

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.

Dr. Ahsan is a neuro-otologist at Henry Ford Hospital, so it seems obvious which “Detroit metropolitan emergency department” the researchers might have studied. He was quoted in a hospital news release.

The problem with CT use in those circumstances is that while intracranial bleeding or stroke may cause dizziness, lots of other causes are more likely. The news release cites dehydration, anemia, drop in blood pressure when standing (orthostatic hypotension), inner-ear problems, and vestibular neuritis.

Dr. Ahsan also noted that previous studies have shown that CT scans don’t do a very good job of detecting stroke or intracranial bleeding in an emergency department setting anyway.

“When a patient comes into the emergency department experiencing dizziness,” he said, “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 imaging yields significant results.”

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Related seminar: Emergency Radiology