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首页> 外文期刊>Journal of Community Hospital Internal Medicine Perspectives >Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies
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Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies

机译：社区医院的头晕：中枢神经系统原因，临床预测指标以及神经影像学研究的诊断率和成本

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ABSTRACT Objectives : Neuroimaging is contributing to the rising costs of dizziness evaluation. This study examined the rate of central neurological causes of dizziness, relevant clinical predictors, and the costs and diagnostic yields of neuroimaging in dizziness assessment. Methods : We retrospectively reviewed the records of 521 adult patients who visited the hospital during a 12-month period with dizziness as the chief complaint. Clinical findings were analyzed using Fisher’s exact test to determine how they correlated with central neurological causes of dizziness identified by neuroimaging. Costs and diagnostic yields of neuroimaging were calculated. Results : Of the 521 patients, 1.5% had dizziness produced by central neurological causes. Gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings predicted central causes. Cases were associated with gait abnormalities, limb ataxia, diabetes mellitus, and the existence of multiple neurological findings . Brain computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 42% and 9.5% of the examined cases, respectively, with diagnostic yields of 3.6% and 12%, respectively. Nine cases of dizziness were diagnosed from 269 brain scans, costing $607?914. Conclusion : Clinical evaluation can predict the presence of central neurological causes of dizziness, whereas neuroimaging is a costly and low-yield approach. Guidelines are needed for physicians, regarding the appropriateness of ordering neuroimaging studies. Abbreviations : OR: odds ratio; CI: confidence interval; ED: emergency department; CT: computed tomography; MRI: magnetic resonance imaging; HINTS: Head impulse, Nystagmus, Test of skew.
机译：摘要目的：神经影像技术正在促进头晕评估费用的上升。这项研究检查了头昏的中枢神经系统原因的发生率，相关的临床预测因素以及头晕评估中神经成像的成本和诊断率。方法：我们回顾性研究了以头晕为主的12个月内来医院就诊的521例成人患者的病历。使用Fisher精确测试对临床发现进行了分析，以确定它们与通过神经影像学确定的头昏的中枢神经系统原因之间的关系。计算了神经影像学的成本和诊断率。结果：在521例患者中，有1.5％的患者因中枢神经系统原因导致头晕。步态异常，肢体共济失调，糖尿病以及多种神经系统检查结果的存在预示了中心原因。病例与步态异常，肢体共济失调，糖尿病以及多种神经系统检查结果有关。分别在42％和9.5％的检查病例中进行了脑计算机断层扫描（CT）和磁共振成像（MRI），诊断率分别为3.6％和12％。通过269次脑部扫描诊断出9例头晕，花费607-914美元。结论：临床评估可以预测出现头昏眼花的中枢神经系统原因，而神经影像检查是一种昂贵且低产的方法。关于订购神经影像学研究的适当性，需要医师指南。缩写：OR：优势比; CI：置信区间; ED：急诊科; CT：计算机断层扫描; MRI：磁共振成像;提示：头部冲动，眼球震颤，偏斜测试。

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