OBJECTIVE
To quantify precision in patient reports of different attributes of dizziness.
PATIENTS AND METHODS
In a cross-sectional study, we interviewed consecutive adult patients with dizziness
at 2 urban academic emergency departments (EDs) from July 2, 2005, to August 26, 2005.
We excluded patients who were too sick for an interview or who posed a risk to the
interviewer. We included those who were “dizzy, light-headed, or off-balance” for
7 days or less or previously “bothered” by the same conditions. We assessed descriptions
of dizziness quality elicited by 4 questions in different formats (open-ended, multiresponse,
single-choice, and directed). Clarity was assessed qualitatively (vague, circular)
and quantitatively (overlap of types of dizziness). Consistency was measured by frequency
of mismatched responses across question formats. Reliability was determined by test-retest.
RESULTS
Of 1342 patients screened, 872 (65%) were dizzy, light-headed, or off-balance in the
past 7 days (n=677) or previously bothered by dizziness (n=195). Among these 872 patients
with dizziness, 44% considered dizziness “the main reason” or “part of the reason”
for the ED visit. Open-ended descriptions were frequently vague or circular. A total
of 62% selected more than 1 dizziness type on the multiresponse question. On the same
question, 54% did not pick 1 or more types endorsed previously in open description. Of 218 patients not identifying vertigo, spinning, or motion on the first 3 questions, 70% confirmed
“spinning or motion” on directed questioning. Asked to choose the single best descriptor,
52% picked a different response on retest approximately 6 minutes later. By comparison,
reports of dizziness duration and triggers were clear, consistent, and reliable.
CONCLUSION
Descriptions of the quality of dizziness are unclear, inconsistent, and unreliable,
casting doubt on the validity of the traditional approach to the patient with dizziness.
Alternative approaches, emphasizing timing and triggers over type, should be investigated.
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Article Info
Footnotes
This work was presented in poster form at the Society of Academic Emergency Medicine 2006 Annual Meeting; May 19, 2006; San Francisco, CA; and published in abstract form
1
; and presented in poster form at the 33rd Annual North American Neuro-Ophthalmology Society Meeting; February 13, 2007; Snowbird, UT; and at the 59th American Academy of Neurology Annual Meeting; May 1, 2007; Boston, MA.Dr Cannon is now with the Thomas Jefferson University, AI duPont Hospital for Children, Wilmington, DE. Dr Stofferahn is now with the Christiana Care Health System, Wilmington, DE
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Copyright
© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Dizziness: How Do Patients Describe Dizziness and How Do Emergency Physicians Use These Descriptions for Diagnosis?Mayo Clinic ProceedingsVol. 82Issue 11
