33: Diagnosing Dizziness in the Emergency Department: Physicians May Rely Too Heavily on Symptom Quality. Results of a Multicenter, Quantitative Survey

Abstract

The textbook approach to diagnosing dizziness relies heavily on initially classifying the patient’s qualitative complaint as vertigo, presyncope, disequilibrium, or ill-defined dizziness, with each “type” indicating a narrow spectrum of possible causes. Specifically, vertigo is said to imply a vestibular problem, presyncope a cardiovascular problem, disequilibrium a neurologic problem, and ill-defined (nonspecific or vague) dizziness a psychiatric or metabolic one. Although this “quality-of-symptoms” approach is cited frequently in medical textbooks and peer-reviewed medical literature, it is unknown whether emergency physicians generally use this approach clinically, nor to what extent it might influence their diagnostic reasoning or management. The relevance of this question is heightened by recent evidence suggesting that emergency department dizzy patient reports of dizziness type are unreliable.