A Comparison of Falls and Dizziness Handicap by Vestibular Diagnosis

Abstract

Purpose There is a paucity of data that directly compares the falls rate and dizziness handicap of different vestibular diagnoses. The purpose of this study is to compare the falls rate and dizziness handicap of common vestibular diagnoses encountered among a cohort of vestibular patients at a single institution. Method We conducted a retrospective cross-sectional study of patients evaluated for dizziness at a tertiary care center vestibular clinic between August 1, 2017, and March 19, 2019. Vestibular diagnosis, demographic variables, comorbidities, falls status, and Dizziness Handicap Inventory (DHI) were extracted from the medical record for analysis. Associations between vestibular diagnosis and falls history or DHI were evaluated using multivariate logistic and linear regression, respectively. Results A total of 283 patients met our inclusion criteria with the following diagnoses: benign paroxysmal positional vertigo (BPPV; n = 55), acoustic neuroma ( n = 30), Ménière's disease ( n = 28), multiple vestibular diagnoses ( n = 15), vestibular migraine ( n = 135), or vestibular neuritis ( n = 20). After adjusting for age, sex, race, medications, and comorbidities, the odds of falling was 2.47 times greater (95% CI [1.08, 6.06], p = .039) and the DHI score was 11.66 points higher (95% CI [4.99, 18.33], p < .001) in those with vestibular migraine compared to those with BPPV. Other diagnoses were comparable to BPPV with respect to odds of falling and dizziness handicap. Conclusions Patients with vestibular migraine may suffer an increased risk of falls and dizziness handicap compared to patients with BPPV. Our findings highlight the need for timely evaluation and treatment of all patients with vestibular disease.

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE‐3): Acute dizziness and vertigo in the emergency department

“…The major harm of missing a TIA is that, untreated, 5% of TIA patients have a stroke in the days following the TIA, 215 and some data suggest that short‐term stroke risk is higher in patients with posterior circulation TIA 158 . Potential harms of missed vestibular migraine diagnosis include more ED visits for persistent symptoms, falls, and injuries 216,217 . CT is associated with economic (cost), health (radiation exposure), and logistical (longer ED length of stay) harms without adding much value 12,41,43,48 .…”

“…158 Potential harms of missed vestibular migraine diagnosis include more ED visits for persistent symptoms, falls, and injuries. 216,217 CT is associated with economic (cost), health (radiation exposure), and logistical (longer ED length of stay) harms without adding much value. 12,41,43,48 Our patient representatives highly valued accurate diagnosis (even for non-TIA diagnoses) based on preventable recurrence, ED visits, and earlier initiation of treatment.…”

A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research

“…Four studies collected posturography measures for standing sway or stability using ground reaction forces from force plates or body sensors [34,[170][171][172], and an additional four collected measures of gait symmetry [160,[167][168][169]. While each of these clinical balance outcomes evaluated has shown some links to fall risk [154,187,[190][191][192], there remains much debate about the best measures of balance for predicting falls [193][194][195]. Future studies should consider recently validated outcome measures, which take into account the dynamic conditions of balance such as the Balance Evaluation Systems Test (BEST), or miniBEST, which have shown promise in identifying and differentiating balance and gait deficits [196][197][198] as well as correlations Grabowska et al Musculoskeletal Disorders (2022) 23:844 to falls in the older population [199,200].…”

Acute dizziness: A personal journey through a paradigm shift

“…Vestibular migraine, for example, is a very common diagnosis 41,42 that we do not need to necessarily make in the ED, but it can result in falls and disability if not made in follow-up. [41][42][43][44] Gauging uncertainty, and then knowing how to communicate it, is a key skill for all physicians.…”

“…They may not understand that our prime directive is to rule out “badness” and not necessarily to make non –life‐, limb‐, or brain‐threatening diagnoses, but there is a big difference between saying, “You don't have a stroke, take some meclizine and see your PCP,” versus “You don't have a stroke, we've done these tests, but you'll need more outpatient testing to find out what is causing your dizziness. You should see your PCP but you may also need to see a neurologist or ENT doctor.” Vestibular migraine, for example, is a very common diagnosis 41,42 that we do not need to necessarily make in the ED, but it can result in falls and disability if not made in follow‐up 41–44 . Gauging uncertainty, and then knowing how to communicate it, is a key skill for all physicians.…”