Dizziness Diagnostic Pathways: Factors Impacting Setting, Provider, and Diagnosis at Presentation

Abstract

Objective Ensuring that patients with dizziness present to the most appropriate level of care and provider are key goals of quality and cost improvement efforts. Using a symptom-defined cohort of adults presenting for dizziness evaluations, we aimed to identify patient factors associated with ambulatory clinic vs emergency department (ED) presentations, evaluating provider specialty, and assigned diagnoses. Study Design Cross-sectional study. Setting OptumLabs Data Warehouse (OLDW), a longitudinal, real-world data asset with deidentified administrative claims. Methods We performed a cross-sectional analysis of adults (older than 18 years) who received new dizziness diagnoses (2006-2015) and identified factors associated with setting and provider at initial presentation using multivariable regression models. Results Of 805,454 individuals with dizziness (median age 52 years, 62% women, 29% black, Asian, or Hispanic), 23% presented to EDs and 77% to clinics (76% primary care, 7% otolaryngology, 5% cardiology, 3% neurology). Predictors of ED presentation were younger age, male sex, black race, lower education, and medical comorbidity. Predictors of primary care clinic presentation were older age and race/ethnicity other than white. Nonetiologic symptom diagnoses alone were assigned to 51% and were most associated with age older than 75 years (odds ratio, 2.90; 95% CI, 2.86-2.94). Conclusion Adults with dizziness often present to a level of care that may be higher than is optimal. Differential care seeking and diagnoses by age, sex, and race/ethnicity reflect influences beyond dizziness presentation acuity. Targeted patient resources, triage systems, provider education, and cross-specialty partnerships are needed to direct dizzy patients to appropriate settings and providers to improve care.

An Exploration of Online Support Community Participation Among Patients With Vestibular Disorders

“…Our cohort is largely composed of non‐Hispanic white, female, and educated participants with broad national and a quarter international representation. The number of female users in this sample is consistent with multiple studies indicating female preponderance among users of online OSCs and those presenting with a chief complaint of dizziness 2,19 . Also, consistent is that almost half of our cohort saw five or more providers before receiving a primary diagnosis.…”

“…The number of female users in this sample is consistent with multiple studies indicating female preponderance among users of online OSCs and those presenting with a chief complaint of dizziness. 2,19 Also, consistent is that almost half of our cohort saw five or more providers before receiving a primary diagnosis. High costs related to healthcare are collected for patients with dizziness and vertigo.…”

“…23 Most patients with dizziness first present to primary care providers, where only a fraction (16%) receive a diagnosis upon first presentation. 19 Further, 42% of our cohort carried a primary or secondary VM diagnosis, a condition known to have broad overlap of symptoms with other disease processes, including Meniere's and idiopathic intracranial hypertension. 28 The asynchronous temporal onset of migraine and vertigo can make VM a challenging diagnosis.…”

“…Adding additional challenges, vestibular disorders can be difficult to diagnose, and there is discrepancy in treatment algorithms for many conditions presenting with vestibular symptoms. [19][20][21] For these reasons, this population may particularly benefit from peer support; however, no academic literature exists investigating OSCs for individuals with general vestibular symptoms such as dizziness or vertigo. The purpose of this study is to document OSC use among patients with vestibular symptoms and to gain a further appreciation for the perceived influence on psychosocial outcomes and impact on medical decision-making.…”

“…The intrusiveness of symptoms, uncertainty in which they may arise, and negative impact on activities of daily living create a substantial psychological burden. Adding additional challenges, vestibular disorders can be difficult to diagnose, and there is discrepancy in treatment algorithms for many conditions presenting with vestibular symptoms 19–21 . For these reasons, this population may particularly benefit from peer support; however, no academic literature exists investigating OSCs for individuals with general vestibular symptoms such as dizziness or vertigo.…”