Dizziness and vertigo are among the most common presenting symptoms in both the emergency department (ED) and ambulatory outpatient clinics, with recent estimates suggesting roughly 18 million visits per year in the US (nearly 5 million to EDs and >13 million to outpatient clinics). These symptoms are caused by a wide array of conditions, but the most common benign causes are otologic, and the most common dangerous cause is stroke. Stroke accounts for 3% to 5% of dizziness presentations in the ED, and some evidence suggests that it may ac count for a similar percentage of dizziness presentations in ambulatory care clinics. Frontline clinicians are often poorly equipped to differentiate peripheral from central vestibular causes and are justifiably worried about missing strokes, so they often resort to neuroimaging as a knee-jerk diagnostic test response. Unfortunately, this choice leads to substantial ill effects, including frequent misdiagnoses and unnecessary imaging for millions of patients with inner ear causes of dizziness who should receive a diagnosis at the bedside, thus exposing patients to unnecessary irradiation (in the case of computed tomography [CT] scans) and incurring significant health care costs. Some estimates suggest that more than $1 billion is wasted each year on inappropriate CT scans alone.
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