Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin.

Müller, Martin; Goeldlin, Martina B.; Gaschen, Janika; Sauter, Thomas C.; Stock, Stephanie; Wagner, Franca; Exadaktylos, Aristomenis K.; Fischer, Urs; Kalla, Roger; Mantokoudis, Georgios (2020). Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin. BMC emergency medicine, 20(1), p. 70. BioMed Central 10.1186/s12873-020-00361-8

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BACKGROUND

Vestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations.

METHODS

This retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was 'vestibular symptoms'. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis.

RESULTS

A total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians' work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging.

CONCLUSION

One in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ear, Nose and Throat Disorders (ENT)
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Müller, Martin; Göldlin, Martina Béatrice; Sauter, Thomas; Wagner, Franca; Exadaktylos, Aristomenis; Fischer, Urs and Mantokoudis, Georgios

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1471-227X

Publisher:

BioMed Central

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

23 Sep 2020 12:23

Last Modified:

27 Sep 2020 02:51

Publisher DOI:

10.1186/s12873-020-00361-8

PubMed ID:

32867677

Uncontrolled Keywords:

Dizziness Emergency department Health resources Resource allocation Vertigo Vestibular

BORIS DOI:

10.7892/boris.146654

URI:

https://boris.unibe.ch/id/eprint/146654

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