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• W2892010183 abstract "There are 7.5 million patients who visit the emergency department (ED) annually with a chief complaint of dizziness. There is a wide range of both benign and serious diagnoses which need to be considered when approaching these patients. This breadth of possibilities results in significant variability in both the evaluation and disposition of these patients. Even after completing an ED workup, emergency physicians may still be unable to provide patients a clear diagnosis/prognosis leading to significant dissatisfaction on the part of the patient and the provider. The outcomes stemming from this uncertainty have not fully been described, especially in the community hospital setting. Our study objective was to provide outcome data to this unfiltered cohort of patients by performing structured 7- and 30-day follow-ups on all ED patients presenting with a chief complaint of dizziness. From June 1-31 2016 we conducted a prospective observational study of consecutive adult (age>18) ED patients presenting with a chief complaint of dizziness. Each patient's chart was reviewed using a preformed data extraction sheet to collect baseline historical/physical characteristics, lab/imaging results, and disposition. Patients whose diagnosis was clearly apparent and non-neurological (ie, gastrointestinal bleed or arrhythmia) were excluded during their index visit. Patients were separated into 3 main cohorts at the time of ED disposition: 1) Suspected/Identified benign diagnosis [BENI], 2) Suspected/Identified serious diagnosis [SERI], or 3) Unclear diagnosis [UNK]. Subsequently, at 7 and 30 days following the index visit, all patients were contacted via a scripted phone survey to determine symptom status and readmission rates. Our primary outcomes were the resolution of symptoms at 7 and 30 days for all 3 cohorts. Our secondary outcomes included ED disposition and rehospitalization rate across all 3 cohorts. Data were analyzed using descriptive statistics and 95% confidence intervals were calculated using the modified Wald method. A total of 127 “dizzy” patients were included in the final analysis. Their average age was 56.7 years and 62.3% were female. At the time of ED disposition, 46/127 (36.2%) of the patients comprised the UNK, while 71/127 (55.9%) were BENI and 10/127 (7.8%) were SERI. Within UNK 28/46 (60.8%) were admitted to the hospital or placed in ED observation compared to 16/71 (22.5%) for BENI and 10/10 (100%) for SERI. The primary outcomes and rehospitalization rates across all 3 cohorts are described in Table 1. There was no statistically significant difference across all 3 cohorts in regards to symptoms improvement or rehospitalization rate. 54.3% of UNK patients had improvement in their symptoms at 7 days, which continued to trend upwards to 65.2% at 30 days. In a consecutive sample of adult ED patients presenting with a chief complaint of dizziness, the majority of patients reported symptom improvement at both 7 and 30 days. However, the ED disposition diagnosis was unable to prognosticate this difference.Table 1Symptom Improvement and Rehospitalization Rates Across All 3 CohortsSymptom Improvement at 7 daysSymptom Improvement at 30 daysRehospitalization within 30 daysUNK25/46 (54.3% CI 40.2% - 67.9%)30/46 (65.2% CI 50.8% - 77.4%)3/46 (6.5% CI 1.6% - 18.2%)SERI9/10 (90% CI 57.4% - 99.9%)9/10 (90% CI 57.4% - 99.9%)2/10 (20% CI 4.6% - 52.1%)BENI52/71 (73.2% CI 61.9% - 82.2%)52/71 (73.2% CI 61.9% - 82.2%)1/71 (1.4% CI 0.01% - 8.3%) Open table in a new tab" @default.
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• W2892010183 date "2018-10-01" @default.
• W2892010183 modified "2023-09-27" @default.
• W2892010183 title "343 When Will I Feel Better: 7- and 30-Day Follow-Ups of Adult Patients Presenting With Dizziness" @default.
• W2892010183 doi "https://doi.org/10.1016/j.annemergmed.2018.08.348" @default.
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