Dizziness Diagnostic Pathways: Factors Impacting Setting, Provider, and Diagnosis at Presentation (2022, Adams and Marmor)
This study looked at where 805,454 adults in the United States who had a new dizziness or vestibular diagnosis between 2006 and 2015 went first for care. Among this group, 23% first went to emergency rooms and 77% first went to outpatient clinics, the majority of which were primary care. The study also found that many people received a nonspecific dizziness diagnosis at the first visit. For Dizzy Care Network, this research strongly supports the need for better dizziness care navigation. Many people with dizziness may not know whether they should go to primary care, the emergency department, or a specialist. A structured intake and triage process may help care-seekers move toward a more appropriate care pathway sooner, while still identifying symptoms that may require urgent care.
Permanent Link: https://doi.org/10.1177/01945998211004245
Why is this research important for dizziness care?
This research is important because the first step in dizziness care matters. Where a person goes first can affect what testing they receive, what diagnosis they are given, how quickly they get treatment, and how much care costs.
The study found that many people with dizziness first present to the emergency department. Some emergency visits are appropriate, especially when dizziness could be related to an urgent condition. However, many dizziness problems can be evaluated in outpatient settings when red flags are not present. Helping people choose the right setting may reduce unnecessary testing, improve follow-up, and support better use of healthcare resources.
The study also showed that most outpatient dizziness care begins in primary care. This means primary care clinicians play a major role in early dizziness evaluation and referral decisions. Better dizziness education, triage tools, and cross-specialty referral pathways may support primary care doctors and help patients get to the right clinician sooner.
Key takeaways for Care Seekers
- It is common to be unsure of which care to go to first.
- Some dizziness symptoms need urgent medical care.
- Many dizziness problems can start with outpatient care, especially when there are no urgent warning signs.
- A questionnaire cannot diagnose you, but it can help organize your symptoms and guide you toward a more relevant care pathway.
- Getting to the right clinician sooner may reduce delays, repeated visits, and confusion.
Key takeaways for Clinicians
- Emergency department presentation was associated with younger age, male sex, Black race, lower education level, and higher medical comorbidity. Outpatient clinic presentation was more likely among women, adults over 40, Asian patients, and those with higher education levels.
- Only 16% of patients received a specific vestibular disorder diagnosis at the initial encounter.
- The findings suggest that dizziness care pathways are influenced by more than symptom acuity alone, including socio-demographic factors, healthcare access, referral patterns, and healthcare system structure.
- The study supports targeted patient education, triage systems, primary care education, and cross-specialty partnerships to improve dizziness care.
- For care navigation, the findings support structured intake tools that help identify urgent symptoms, guide appropriate site of care, and route patients toward relevant clinicians.