Henry Ford Hospital researchers have found that conducting CT scans in the emergency department (ED) for individuals experiencing dizziness may not be cost effective. The researchers discovered that less than 1% of CT scans carried out in the ED showed a more serious underlying cause for dizziness (stroke or intracranial bleeding), which required intervention. The finding comes at a time when hospitals across the nation seek ways to reduce costs without sacrificing patient care.
The retrospective study was presented January 26, 2012, In Miami Beach, at the annual Triological Society's Combined Sections Meeting.
According to the researchers, it may be more cost effective for hospitals to implement stricter guidelines for performing ED CT scans of the head and brain of individuals experiencing dizziness.
Study author Syed F. Ahsan, M.D., a neuro-otologist in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford, explained:
"When a patient comes into the emergency department experiencing dizziness, 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 imagining yields significant results.
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 healthy systems."
The researchers examined 1,681 individuals with vertigo or dizziness, between January 2008 and January 2011, who came into a Detroit metropolitan ED.
Almost half (810) of the 1,681 patients underwent a CT scan of the brain and head. However, the researchers found that only 0.74% of the 810 CT scans conducted produced clinically significant results that required intervention. During the three-year period, the total cost for CT scans was $988,200.
Furthermore, results showed that CT scans were more likely to be performed on older patients and those with a lower income who experienced dizziness when they entered the ED.
Although dizziness may be a sign of stroke or intracranial bleeding, it is usually caused by:
- decreased blood pressure when standing (orthostatic hypotension)
- labyrinthitis or meniere's disease
- estibular neuritis
- problems or inflammation in the inner ear, such as benign paroxysmal postional vertigo
This study demonstrates the potential for cost effectiveness by developing and implementing stricter guidelines to determine when it is medically required for individuals experiencing dizziness to receive CT scans in the ED.
Co-authors of the Henry Ford study are Mausumi N. Syamal, M.D., and Kathleen Yaremchuk, M.D.
Written by Grace Rattue