Profiling the Pathway of the Dizzy Patient in the Emergency Department from the Triage and Onwards

Abstract

Background: Dizziness is a common complaint among patients seeking medical assistance in the Emergency Departments (EDs). Although its aetiology is usually benign, patients often follow a complex pathway with health service and resource overuse.  Aims of this study were to describe the symptoms and characteristics of such subjects and gain an overall impression of their management by ED physicians.  Methods: Our study was performed in the University Hospital of Heraklion, Crete, Greece. We retrospectively collected demographic, clinical and co-morbidity data of patients visiting the ED complaining of dizziness during a 3-month period. These were evaluated initially by general practitioners (GPs) in the triage and then referred to other specialists, if needed.  Results: In total, 408 self-referred patients visited the triage of the ED complaining of dizziness. The most common accompanying symptoms of dizziness were vertigo, headache, fatigue, nausea and imbalance. Relevant concomitant chronic diseases included hypertension, coronary artery disease and diabetes mellitus. After the initial triage, most patients were referred to an internist or an otorhinolaryngologist, or remained in the triage for further work up.  Conclusion: Our study underlines the difficulty to diagnose and refer cases with dizziness faced by triage GPs in the ED. There is a great variability of symptoms accompanying dizziness and GPs face the challenge to discharge or refer to specialists for further examination. An educational need for GPs and the devise of simple but efficient diagnostic algorithms have emerged as unmet needs.