Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury

Abstract

Objective: To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms. Setting: Administrative medical record data from the Department of Veterans Affairs (VA). Participants: Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation. Design: A cross-sectional, retrospective, observational study. Main Measures: International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory. Results: Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses. Conclusions: Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.

Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury

“…73,74 The vestibular subscale may not be sensitive enough to independently measure vestibular function as it consists of three subjective symptoms: dizziness, clumsiness, and loss of balance. There are few studies examining the validity of this subscale, 75 whereas no data exist regarding comparison to the "gold standard" (ie, caloric testing). 73…”

Guideline Adherence to Benign Paroxysmal Positional Vertigo Treatment and Management in Primary Care

“…Swan et al examined factors impacting whether or not veterans with dizziness symptomatology received a diagnosis of dizziness versus a vestibular disorder. They found that black veterans had significantly reduced odds of receiving a vestibular disorder diagnosis when compared to white individuals 21 . Another recent study by Souza et al 22 examined geographic variation in the care of patients with a vestibular disorder and found that location impacted management.…”

“…They found that black veterans had significantly reduced odds of receiving a vestibular disorder diagnosis when compared to white individuals. 21 Another recent study by Souza et al 22 examined geographic variation in the care of patients with a vestibular disorder and found that location impacted management. Despite these newer studies and a call to increase research investigating variations in care for BPPV, there have been no further studies investigating whether there are sociodemographic variations in the diagnosis or management of dizziness etiology such as BPPV.…”