OBJECTIVE
To assess emergency physicians' diagnostic approach to the patient with dizziness,
using a multicenter quantitative survey.
PARTICIPANTS AND METHODS
We anonymously surveyed attending and resident emergency physicians at 17 academic-affiliated
emergency departments with an Internet-based survey (September 1, 2006, to November
3, 2006). The survey respondents ranked the relative importance of symptom quality,
timing, triggers, and associated symptoms and indicated their agreement with 20 statements
about diagnostic assessment of dizziness (Likert scale). We used logistic regression
to assess the impact of “symptom quality ranked first” on odds of agreement with diagnostic
statements; we then stratified responses by academic rank.
RESULTS
Of the 505 individuals surveyed, 415 responded for an overall response rate of 82%.
A total of 93% (95% confidence interval [CI], 90%-95%) agreed that determining type
of dizziness is very important, and 64% (95% CI, 60%-69%) ranked symptom quality as
the most important diagnostic feature. In a multivariate model, those ranking quality
first (particularly resident physicians) more often reported high-risk reasoning that
might predispose patients to misdiagnosis (eg, in a patient with persistent, continuous
dizziness, who could have a cerebellar stroke, resident physicians reported feeling
reassured that a normal head computed tomogram indicates that the patient can safely
go home) (odds ratio, 6.74; 95% CI, 2.05-22.19).
CONCLUSION
Physicians report taking a quality-of-symptoms approach to the diagnosis of dizziness
in patients in the emergency department. Those relying heavily on this approach may
be predisposed to high-risk downstream diagnostic reasoning. Other clinical features
(eg, timing, triggers, associated symptoms) appear relatively undervalued. Educational
initiatives merit consideration.
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Article Info
Footnotes
This work was presented in poster form at the American College of Emergency Physicians 2007 Annual Meeting; October 8, 2007; Seattle, WA.
Identification
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
- CorrectionMayo Clinic ProceedingsVol. 88Issue 7
- PreviewIn the article “Overreliance on Symptom Quality in Diagnosing Dizziness: Results of a Multicenter Survey of Emergency Physicians,” which appeared in the November 2007 issue of Mayo Clinic Proceedings (2007;82(11):1319-1328), an author's name was listed incorrectly. Paris Lovett should have been listed as Paris B. Lovett.
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