Ten Year Trends of Dizziness in the Emergency Department

Ten Year Trends of Dizziness in the Emergency Department | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ten Year Trends of Dizziness in the Emergency Department Razmig Garabet, David Tran, Zihan Huang, Michael Howley, Michael Weingarten This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4410707/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Dizziness is common reason for visit to the emergency department (ED), which impacts patient well-being and places significant demands on healthcare resources. Despite its prevalence, the trends of patient presentation and healthcare utilization has not been assessed for decades. Objectives To comprehensively analyze 10-year trends of patient presentation and healthcare utilization of dizziness attributed visits to the ED. Methods The National Hospital Ambulatory Medical Care Survey (NHAMCS) was used to obtain data for patients that visited the emergency department for dizziness from 2010 to 2019. Nationally representative estimates were derived for patient demographics and diagnostics. Trend analyses were conducted to investigate potential patterns and implications. Results A total of 1.3 billion dizziness attributed ED visits were estimated from 2010 to 2019 with a significant increase per year and a 49.23% increase over the decade (p<.001). Diagnostic imaging has significantly increased for this population (p=.005). However, the amount of head CT scans ordered have remained stable (p=.201). The number of medications provided during these visits have significantly increased (p=.005), without any difference in the rate of being admitted to the hospital (p=.231). Conclusion The rate of ED visits attributed to dizziness has continued to rise in the recent decade. There are notable presentation rates for ED dizziness visits depending on patient age, sex, and race. Although overall utilization of imaging has increased, orders for head CT has remained stable. Critical Care & Emergency Medicine dizziness vertigo emergency department presentation healthcare utilization Figures Figure 1 Figure 2 Figure 3 Introduction Dizziness is commonly experienced within the United States population with prevalence rates between 14–36% [ 1 – 3 ]. Dizziness and vertigo are often a reason for visit within ambulatory care settings, with rates of 8.8 per 1,000 visits in the US and up to 15.5% internationally [ 4 – 5 ]. Specifically, within the US emergency department (ED), it was estimated that 3.3% of total visits were attributed to dizziness cases [ 6 ]. Patient presentation for dizziness can be rather ambiguous, inconsistent, and unreliable [ 7 ]. This imprecision, in conjunction with the wide variety of possible etiologies can lead to diagnostic challenges for physicians [ 8 ]. An estimated 48% of this population undergoes diagnostic imaging during their emergency visit, of which only 0.74% yielded evidence for a pathology that would require intervention [ 9 ]. The US costs for ED dizziness presentations are exceeding $ 4 billion per year, accounting for 4% of total ED costs, and continue to rise annually [ 10 ]. These factors raise a concern for an inefficiency of healthcare utilization for dizziness presentations to the ED. The purpose of this study is to comprehensively analyze 10-year trends in the presentation of dizziness to the ED. A previous study has examined these characteristics within the early 2000s by combining multiple years of data [ 11 ]. We expanded these observations to the recent decade (2010–2019) and analyzed apparent trends of healthcare utilization and presentation on a yearly basis. Materials and Methods Study Design The National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative secondary database, was used for this study. [ 12 ]. A cross-sectional retrospective design was adopted. The time-period of interest were individual years of 2010 through 2019. Data utilized within this study are deidentified and publicly available, which allow it to be exempt from review by the Institutional Review Board. Data Source Data were obtained from the NHAMCS, which provides information on nationally representative samples of hospital ambulatory care departments within the US. The data is collected, compiled, and coded for by the US National Center for Health Statistics (NCHS) and released publicly online [ 12 ]. The NHAMCS adopts a four-stage probability design and annually examines visits to emergency and outpatient departments within noninstitutional general and short-stay hospitals throughout the nation, excluding Federal, military, and Veterans Administration hospitals [ 13 ]. A detailed explanation of the methodology and documentation for the NHAMCS are provided by the NCHS [ 14 ]. The NHAMCS divides their data set by an emergency department file, outpatient department file, and documentation file for each year since 1992. The current study used the data from the emergency department and documentation files for the years of 2010 through 2019. These years were chosen to reflect information for a 10-year span in the recent decade. Data Management ED visits that were attributed to dizziness were determined by examining the reason for visit (RFV) variable of each event. The RFV classifies the specific concerns that prompted the visit to the emergency department [ 15 ]. The RFV code “12250” was chosen as it represents an umbrella term for “vertigo-dizziness”, which includes falling sensation, giddiness, lightheadedness, loss of sense of equilibrium or balance, and room spinning [ 16 ]. Prior to 2014, there were only three entries available for RFV, but expanded to five possible entries thereafter. A patient was selected into the study group if they had exhibited the aforementioned code in one of the available RFV entry fields. For each dizziness ED visit, the extracted variables of interest were manually categorized into groups of demographic variables, event variables, chronic conditions variables, imaging variables, and medication variables. The demographic variables included the patient’s age, age range, sex, and race. The event variables identified the physician’s diagnosis for the specific case. Similar to the RFV variable, the physician’s diagnoses variable had three data entry fields available prior to 2014 and five thereafter. Additionally, starting from the 2016 dataset, there was a switch from utilizing ICD-9-CM codes to the currently implemented ICD-10-CM codes. The chronic conditions variables identified potential comorbidities that the patient had presented with, listing the most common conditions and total amount of conditions. The imaging variables included computed tomography (CT) or any image. Lastly, the medication variables provided information for the number of different medications administered during the visit. Data Analysis Statistical analyses were conducted using IBM SPSS 29. Yearly data for each of the variables were collected from 2010 to 2019 and converted into nationally representative estimates using the sampling weight protocol provided by the NHAMCS [ 13 ]. Proportions of ED dizziness visits were determined by a ratio of the total ED visits to the number of visits for each year. For each individual trend analysis, the independent variable was the year progression and the dependent variable was the studied variable based on dizziness attributed visits per 1,000 ED visits. Logistic regression was used to estimate predictors of image utilization. The discharge diagnoses were calculated as the total number of diagnoses and the frequencies of the most common diagnoses. Results A total of 8,143 dizziness cases were identified from a sample of 221,914 ED visits between 2010–2019. These values translate to 47.8 million dizziness cases in a total of 1.3 billion ED visits during the decade. Dizziness visits were attributed to 3.67% of all ED visits (95% CI: 3.59 to 3.75). The amount of ED visits for dizziness demonstrated a significant trend from 2010 to 2019 [R 2 = .803, F(1,8) = 32.54, p < .001]. Specifically, there was an increase in dizziness ED visits as each year passed (B = 1.66). From 2010 to 2019, there was a 49.23% increase in the amount of ED visits attributed to dizziness (Fig. 1 ). Table 1 demonstrates the trends for demographic characteristics of ED dizziness visits. There were significant trends in individuals aged 15–24 [R 2 = .616, F(1,8) = 12.85, p = .007], 25–44 [R 2 = .799, F(1,8) = 31.74, p < .001], 45–64 [R 2 = .823, F(1,8) = 37.15, p < .001], and 65 and up [R 2 = .403, F(1,8) = 32.54, p < .001]. Age group 15–24 demonstrated the largest increase (B = 2.27), followed by 45–64 (B = 2.08), 25–44 (B = 1.88), and then 65 and up (B = 0.49). There was no significant trend for individuals aged 0–14 years [R 2 = .100, F(1,8) = .891, p = .373]. There were significant trends in ED dizziness visits for both males [R 2 = .769, F(1,8) = 26.64, p < .001] and females [R 2 = .640, F(1,8) = 14.20, p = .005]. Rates of increase were similar in both sexes, but slightly higher in females (B = 1.64) than males (B = 1.41). In regard to race, both black [R 2 = .564, F(1,8) = 10.33, B = 1.59, p = .012] and white [R 2 = .463, F(1,8) = 6.89, B = 1.625, p = .030] people demonstrated significant trends in ED dizziness visits. However, people who identified with a racial group other than black or white did not demonstrate any significant trend [R 2 = .018, F(1,8) = .151, p = .708]. Figure 2 demonstrates 10-year pooled data for demographic variables as a proportion over total ED dizziness visits. Table 1 Demographic characteristics per 1000 ED dizziness visits yearly from 2010–2019 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Sig Age 0–14 5.54 7.38 7.47 9.06 7.71 8.46 5.78 4.65 10.13 9.41 .373 15–24 23.11 23.19 20.63 20.88 23.45 30.67 43.64 27.54 40.89 38.73 .007 25–44 27.57 29.75 25.35 30.81 34.62 35.97 42.45 36.24 38.56 45.04 < .001 45–64 37.70 32.73 40.03 40.06 37.34 42.84 49.73 51.70 50.08 52.02 < .001 65 & Up 54.36 54.08 49.89 64.02 53.76 63.76 76.08 60.18 59.90 70.39 < .001 Sex Male 24.68 27.67 25.91 28.66 25.76 32.40 36.55 33.32 33.02 38.96 < .001 Female 35.96 29.90 30.66 36.03 35.69 38.08 47.93 37.60 45.14 46.10 .005 Race White 28.52 28.51 29.09 33.43 34.57 22.04 44.98 36.56 39.12 43.45 .030 Black 26.74 26.11 26.90 28.07 23.26 22.53 35.19 31.71 38.95 40.89 .012 Other 45.55 52.77 28.64 48.63 25.67 16.75 46.00 49.83 55.54 44.18 .708 Utilization of diagnostic imaging during ED visits for dizziness demonstrated a significant change over the 10-year period examined [R 2 = .651, F(1,8) = 14.90, p = .005]. Specifically, more diagnostic imaging was being ordered for this population over time (B = .519). However, utilization of head CTs did not appear to change over this period [R 2 = .194, F(1,8) = 1.92, p = .203]. There was no change in the number of diagnoses provided for individuals who present to the ED with a chief complaint of dizziness [R 2 = .139, F(1,8) = 1.29, p = .289]. The most common ICD diagnoses provided were dizziness, syncope, hypertension, and headache (Fig. 3 ). The number of medications provided for these visits have been shown to change [R 2 = .649, F(1,8) = 14.78, p = .005]. Providers appear to be providing slightly increased amounts of medications for ED dizziness visits (B = .067). There were no changes in the rates of being admitted to the hospital when presenting to the ED with dizziness [R 2 = .174, F(1,8) = 1.68, p = .231]. Logistic regression was used to determine predictors for increased image utilization in ED dizziness visits. Female sex (p < .001) and increasing age (p < .001) were the only variables that showed a significant influence on the likelihood of obtaining any diagnostic imaging during the ED visit. Differences in race and ethnicity were not predictors for image utilization. Discussion The purpose of the present study was to assess presentation and healthcare utilization trends for ED dizziness visits. This was accomplished by using nationally representative data to track yearly changes from 2010 to 2019. Elucidation of these trends are critical to provide insight on clinical approach, management, patient education, diagnostic usage, and hospital expenses for patients who present to the ED with a complaint of dizziness. Within the past decade, dizziness composed 3.67% of primary complaints to the ED. This rate has also increased by nearly half from 2010 to 2019. This was in substantial contrast to the 2.5% dizziness-attributed ED visits and 37% increase in dizziness ED visits from 1995 to 2004 [ 3 ]. Therefore, it is clear from our findings that we continue to see more and more patients presenting to the ED for a complaint of dizziness and that slope of change continues to increase by every consecutive year. This could be due to a myriad of factors including an aging population with a higher prevalence of medical conditions, increased prevalence of risk factors such as hypertension and obesity, mental health factors, and potential shifts in emergency care trends. Although most age groups demonstrated increases in ED dizziness visits, there was a substantially larger increase in younger populations under the age of 65 than those over that age. Teens and young adults aged 15–24 showed the highest increase for ED dizziness visits from all other age groups. This suggests that younger patients are either developing an increased susceptibility to dizziness or are becoming more likely to seek emergent evaluation due to increased caution [ 17 ]. Understanding the reasons for this age-related increase in ED visits for dizziness could help tailor interventions and education to specific age groups. Rates of increase in dizziness ED visits were slightly higher in females than males. This finding may reflect gender differences in healthcare-seeking behavior or differences in the prevalence of underlying conditions causing dizziness [ 18 ]. Further research could explore these gender disparities to seek differences in care between genders. There appeared to be a significant increase in the utilization of diagnostic imaging for dizziness ED visits, albeit stability in utilization of CT scans specifically. This suggests that clinicians may be using other imaging modalities when assessing dizziness and are less dependent on immediate head CT scans on initial patient arrival. This trend corroborates a previous study that demonstrated obtaining head MRI scans appear to be more sensitive in highlighting an abnormality than head CT scans in patients who present to the ED with a complaint of dizziness [ 19 ]. Interestingly, during this same time, the overall utilization of head CT scans in the ED have increased by 69% [ 20 ]. This discrepancy may indicate that ED physicians have become more confident and precise in their diagnostic approach in patients presenting with dizziness. The lack of a significant change in the number of diagnoses provided for dizziness cases, along with the high variability in concluded diagnoses, highlights the diagnostic challenge that dizziness presents in the ED. Dizziness is a symptom with a wide range of potential causes, and arriving at a definitive diagnosis can be challenging [ 21 – 22 ]. This finding underscores the need for continued research and development of clinical decision support tools to assist clinicians in identifying the underlying cause of dizziness more efficiently. Limitations Some limitations arise from the NHAMCS data source that was used to accomplish this study. First, the RFV code of interest was listed under the classification of “vertigo-dizziness”. These two terms are not synonymous and thus the data source prevented us from attributing all of the cases to one or another. This is an important distinction because symptoms of vertigo are more likely to be a manifestation of otologic or neurologic etiologies, which may warrant a differing diagnostic pathway than pure dizziness [ 23 – 24 ]. Second, although there was data on whether a head CT was ordered during the ED encounter, there was no data on the utilization of a head MRI. Thus, it was not possible to compare changes in utilization between the two imaging modalities. Conclusions This study provides valuable insights into the trends and characteristics of ED visits for dizziness over a decade. The significant increase in such visits emphasizes the need for improved strategies for evaluating and managing dizziness in the ED. Tailoring interventions to specific age groups and addressing potential gender disparities in healthcare-seeking behavior are areas that warrant further investigation. Additionally, the development of more accurate and efficient diagnostic tools for dizziness should be a priority to enhance patient care, improve clinician assessments, and reduce healthcare costs. References Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. 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Published 2018 Feb 20. doi:10.1186/s12875-017-0695-0 Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc . 2008;83(7):765-775. doi:10.4065/83.7.765 Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc . 2007;82(11):1329-1340. doi:10.4065/82.11.1329 Goeldlin M, Gaschen J, Kammer C, et al. Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag. J Neurol . 2019;266(12):3076-3086. doi:10.1007/s00415-019-09525-4 Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. 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Schneider D, Appleton L, McLemore T. A reason for visit classification for ambulatory care. Vital Health Stat 2 . 1979;(78):i-63. Centers for Disease Control and Prevention. National Center for Health Statistics. 2019 NHAMCS Micro-data File Documentation. 2019. Available online: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc19-ed-508.pdf. Filippopulos FM, Albers L, Straube A, et al. Vertigo and dizziness in adolescents: Risk factors and their population attributable risk. PLoS One . 2017;12(11):e0187819. Published 2017 Nov 13. doi:10.1371/journal.pone.0187819 Teggi R, Manfrin M, Balzanelli C, et al. Point prevalence of vertigo and dizziness in a sample of 2672 subjects and correlation with headaches. Prevalenza dei sintomi vertigine e instabilità in un campione di 2672 soggetti e correlazione con il sintomo cefalea. Acta Otorhinolaryngol Ital . 2016;36(3):215-219. doi:10.14639/0392-100X-847 Alawneh, K. Z., Raffee, L. A., Oqlat, A. A., Oglat, A. A., Al Qawasmeh, M., Ali, M. K., Okour, A. M., & Al-Mistarehi, A. H. (2021). The utility of brain CT scan modality in the management of dizziness at the emergency department: A retrospective single-center study. Annals of medicine and surgery (2012) , 64 , 102220. https://doi.org/10.1016/j.amsu.2021.102220 ElHabr A, Merdan S, Ayer T, et al. Increasing Utilization of Emergency Department Neuroimaging From 2007 Through 2017. AJR Am J Roentgenol . 2022;218(1):165-173. doi:10.2214/AJR.21.25864 Goeldlin M, Gaschen J, Kammer C, et al. Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag. J Neurol . 2019;266(12):3076-3086. doi:10.1007/s00415-019-09525-4 Jung I, Kim JS. Approach to dizziness in the emergency department. Clin Exp Emerg Med . 2015;2(2):75-88. Published 2015 Jun 30. doi:10.15441/ceem.15.026 Della-Morte D, Rundek T. Dizziness and vertigo. Front Neurol Neurosci . 2012;30:22-25. doi:10.1159/000333379 Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol . 2016;137:67-82. doi:10.1016/B978-0-444-63437-5.00005-4 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4410707","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":301695775,"identity":"f5622882-c07e-4d55-8507-825f5f1f7357","order_by":0,"name":"Razmig 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citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Dizziness and vertigo are often a reason for visit within ambulatory care settings, with rates of 8.8 per 1,000 visits in the US and up to 15.5% internationally [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Specifically, within the US emergency department (ED), it was estimated that 3.3% of total visits were attributed to dizziness cases [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient presentation for dizziness can be rather ambiguous, inconsistent, and unreliable [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This imprecision, in conjunction with the wide variety of possible etiologies can lead to diagnostic challenges for physicians [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. An estimated 48% of this population undergoes diagnostic imaging during their emergency visit, of which only 0.74% yielded evidence for a pathology that would require intervention [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The US costs for ED dizziness presentations are exceeding \u003cspan\u003e$\u003c/span\u003e4\u0026nbsp;billion per year, accounting for 4% of total ED costs, and continue to rise annually [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These factors raise a concern for an inefficiency of healthcare utilization for dizziness presentations to the ED.\u003c/p\u003e \u003cp\u003eThe purpose of this study is to comprehensively analyze 10-year trends in the presentation of dizziness to the ED. A previous study has examined these characteristics within the early 2000s by combining multiple years of data [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. We expanded these observations to the recent decade (2010\u0026ndash;2019) and analyzed apparent trends of healthcare utilization and presentation on a yearly basis.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThe National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative secondary database, was used for this study. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A cross-sectional retrospective design was adopted. The time-period of interest were individual years of 2010 through 2019. Data utilized within this study are deidentified and publicly available, which allow it to be exempt from review by the Institutional Review Board.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Source\u003c/h2\u003e \u003cp\u003eData were obtained from the NHAMCS, which provides information on nationally representative samples of hospital ambulatory care departments within the US. The data is collected, compiled, and coded for by the US National Center for Health Statistics (NCHS) and released publicly online [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The NHAMCS adopts a four-stage probability design and annually examines visits to emergency and outpatient departments within noninstitutional general and short-stay hospitals throughout the nation, excluding Federal, military, and Veterans Administration hospitals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A detailed explanation of the methodology and documentation for the NHAMCS are provided by the NCHS [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The NHAMCS divides their data set by an emergency department file, outpatient department file, and documentation file for each year since 1992. The current study used the data from the emergency department and documentation files for the years of 2010 through 2019. These years were chosen to reflect information for a 10-year span in the recent decade.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Management\u003c/h2\u003e \u003cp\u003eED visits that were attributed to dizziness were determined by examining the reason for visit (RFV) variable of each event. The RFV classifies the specific concerns that prompted the visit to the emergency department [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The RFV code \u0026ldquo;12250\u0026rdquo; was chosen as it represents an umbrella term for \u0026ldquo;vertigo-dizziness\u0026rdquo;, which includes falling sensation, giddiness, lightheadedness, loss of sense of equilibrium or balance, and room spinning [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Prior to 2014, there were only three entries available for RFV, but expanded to five possible entries thereafter. A patient was selected into the study group if they had exhibited the aforementioned code in one of the available RFV entry fields.\u003c/p\u003e \u003cp\u003eFor each dizziness ED visit, the extracted variables of interest were manually categorized into groups of demographic variables, event variables, chronic conditions variables, imaging variables, and medication variables. The demographic variables included the patient\u0026rsquo;s age, age range, sex, and race. The event variables identified the physician\u0026rsquo;s diagnosis for the specific case. Similar to the RFV variable, the physician\u0026rsquo;s diagnoses variable had three data entry fields available prior to 2014 and five thereafter. Additionally, starting from the 2016 dataset, there was a switch from utilizing ICD-9-CM codes to the currently implemented ICD-10-CM codes. The chronic conditions variables identified potential comorbidities that the patient had presented with, listing the most common conditions and total amount of conditions. The imaging variables included computed tomography (CT) or any image. Lastly, the medication variables provided information for the number of different medications administered during the visit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were conducted using IBM SPSS 29. Yearly data for each of the variables were collected from 2010 to 2019 and converted into nationally representative estimates using the sampling weight protocol provided by the NHAMCS [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Proportions of ED dizziness visits were determined by a ratio of the total ED visits to the number of visits for each year. For each individual trend analysis, the independent variable was the year progression and the dependent variable was the studied variable based on dizziness attributed visits per 1,000 ED visits. Logistic regression was used to estimate predictors of image utilization. The discharge diagnoses were calculated as the total number of diagnoses and the frequencies of the most common diagnoses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 8,143 dizziness cases were identified from a sample of 221,914 ED visits between 2010\u0026ndash;2019. These values translate to 47.8\u0026nbsp;million dizziness cases in a total of 1.3\u0026nbsp;billion ED visits during the decade. Dizziness visits were attributed to 3.67% of all ED visits (95% CI: 3.59 to 3.75). The amount of ED visits for dizziness demonstrated a significant trend from 2010 to 2019 [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.803, F(1,8)\u0026thinsp;=\u0026thinsp;32.54, p\u0026thinsp;\u0026lt;\u0026thinsp;.001]. Specifically, there was an increase in dizziness ED visits as each year passed (B\u0026thinsp;=\u0026thinsp;1.66). From 2010 to 2019, there was a 49.23% increase in the amount of ED visits attributed to dizziness (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates the trends for demographic characteristics of ED dizziness visits. There were significant trends in individuals aged 15\u0026ndash;24 [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.616, F(1,8)\u0026thinsp;=\u0026thinsp;12.85, p\u0026thinsp;=\u0026thinsp;.007], 25\u0026ndash;44 [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.799, F(1,8)\u0026thinsp;=\u0026thinsp;31.74, p\u0026thinsp;\u0026lt;\u0026thinsp;.001], 45\u0026ndash;64 [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.823, F(1,8)\u0026thinsp;=\u0026thinsp;37.15, p\u0026thinsp;\u0026lt;\u0026thinsp;.001], and 65 and up [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.403, F(1,8)\u0026thinsp;=\u0026thinsp;32.54, p\u0026thinsp;\u0026lt;\u0026thinsp;.001]. Age group 15\u0026ndash;24 demonstrated the largest increase (B\u0026thinsp;=\u0026thinsp;2.27), followed by 45\u0026ndash;64 (B\u0026thinsp;=\u0026thinsp;2.08), 25\u0026ndash;44 (B\u0026thinsp;=\u0026thinsp;1.88), and then 65 and up (B\u0026thinsp;=\u0026thinsp;0.49). There was no significant trend for individuals aged 0\u0026ndash;14 years [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.100, F(1,8)\u0026thinsp;=\u0026thinsp;.891, p\u0026thinsp;=\u0026thinsp;.373].\u003c/p\u003e \u003cp\u003eThere were significant trends in ED dizziness visits for both males [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.769, F(1,8)\u0026thinsp;=\u0026thinsp;26.64, p\u0026thinsp;\u0026lt;\u0026thinsp;.001] and females [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.640, F(1,8)\u0026thinsp;=\u0026thinsp;14.20, p\u0026thinsp;=\u0026thinsp;.005]. Rates of increase were similar in both sexes, but slightly higher in females (B\u0026thinsp;=\u0026thinsp;1.64) than males (B\u0026thinsp;=\u0026thinsp;1.41). In regard to race, both black [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.564, F(1,8)\u0026thinsp;=\u0026thinsp;10.33, B\u0026thinsp;=\u0026thinsp;1.59, p\u0026thinsp;=\u0026thinsp;.012] and white [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.463, F(1,8)\u0026thinsp;=\u0026thinsp;6.89, B\u0026thinsp;=\u0026thinsp;1.625, p\u0026thinsp;=\u0026thinsp;.030] people demonstrated significant trends in ED dizziness visits. However, people who identified with a racial group other than black or white did not demonstrate any significant trend [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.018, F(1,8)\u0026thinsp;=\u0026thinsp;.151, p\u0026thinsp;=\u0026thinsp;.708]. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e demonstrates 10-year pooled data for demographic variables as a proportion over total ED dizziness visits.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics per 1000 ED dizziness visits yearly from 2010\u0026ndash;2019\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSig\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0\u0026ndash;14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e10.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e9.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e15\u0026ndash;24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e30.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e43.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e27.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e40.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e38.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e25\u0026ndash;44\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e35.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e42.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e36.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e38.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e45.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e45\u0026ndash;64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e49.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e51.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e50.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e52.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e65 \u0026amp; Up\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e63.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e76.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e60.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e59.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e70.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e32.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e36.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e33.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e33.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e38.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e36.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e47.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e37.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e45.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e46.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eWhite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e44.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e36.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e39.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e43.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlack\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e22.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e35.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e31.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e38.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e40.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e46.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e49.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e55.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e44.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUtilization of diagnostic imaging during ED visits for dizziness demonstrated a significant change over the 10-year period examined [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.651, F(1,8)\u0026thinsp;=\u0026thinsp;14.90, p\u0026thinsp;=\u0026thinsp;.005]. Specifically, more diagnostic imaging was being ordered for this population over time (B\u0026thinsp;=\u0026thinsp;.519). However, utilization of head CTs did not appear to change over this period [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.194, F(1,8)\u0026thinsp;=\u0026thinsp;1.92, p\u0026thinsp;=\u0026thinsp;.203].\u003c/p\u003e \u003cp\u003eThere was no change in the number of diagnoses provided for individuals who present to the ED with a chief complaint of dizziness [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.139, F(1,8)\u0026thinsp;=\u0026thinsp;1.29, p\u0026thinsp;=\u0026thinsp;.289]. The most common ICD diagnoses provided were dizziness, syncope, hypertension, and headache (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The number of medications provided for these visits have been shown to change [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.649, F(1,8)\u0026thinsp;=\u0026thinsp;14.78, p\u0026thinsp;=\u0026thinsp;.005]. Providers appear to be providing slightly increased amounts of medications for ED dizziness visits (B\u0026thinsp;=\u0026thinsp;.067). There were no changes in the rates of being admitted to the hospital when presenting to the ED with dizziness [R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.174, F(1,8)\u0026thinsp;=\u0026thinsp;1.68, p\u0026thinsp;=\u0026thinsp;.231].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLogistic regression was used to determine predictors for increased image utilization in ED dizziness visits. Female sex (p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and increasing age (p\u0026thinsp;\u0026lt;\u0026thinsp;.001) were the only variables that showed a significant influence on the likelihood of obtaining any diagnostic imaging during the ED visit. Differences in race and ethnicity were not predictors for image utilization.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of the present study was to assess presentation and healthcare utilization trends for ED dizziness visits. This was accomplished by using nationally representative data to track yearly changes from 2010 to 2019. Elucidation of these trends are critical to provide insight on clinical approach, management, patient education, diagnostic usage, and hospital expenses for patients who present to the ED with a complaint of dizziness.\u003c/p\u003e \u003cp\u003eWithin the past decade, dizziness composed 3.67% of primary complaints to the ED. This rate has also increased by nearly half from 2010 to 2019. This was in substantial contrast to the 2.5% dizziness-attributed ED visits and 37% increase in dizziness ED visits from 1995 to 2004 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, it is clear from our findings that we continue to see more and more patients presenting to the ED for a complaint of dizziness and that slope of change continues to increase by every consecutive year. This could be due to a myriad of factors including an aging population with a higher prevalence of medical conditions, increased prevalence of risk factors such as hypertension and obesity, mental health factors, and potential shifts in emergency care trends.\u003c/p\u003e \u003cp\u003eAlthough most age groups demonstrated increases in ED dizziness visits, there was a substantially larger increase in younger populations under the age of 65 than those over that age. Teens and young adults aged 15\u0026ndash;24 showed the highest increase for ED dizziness visits from all other age groups. This suggests that younger patients are either developing an increased susceptibility to dizziness or are becoming more likely to seek emergent evaluation due to increased caution [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Understanding the reasons for this age-related increase in ED visits for dizziness could help tailor interventions and education to specific age groups.\u003c/p\u003e \u003cp\u003eRates of increase in dizziness ED visits were slightly higher in females than males. This finding may reflect gender differences in healthcare-seeking behavior or differences in the prevalence of underlying conditions causing dizziness [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Further research could explore these gender disparities to seek differences in care between genders.\u003c/p\u003e \u003cp\u003eThere appeared to be a significant increase in the utilization of diagnostic imaging for dizziness ED visits, albeit stability in utilization of CT scans specifically. This suggests that clinicians may be using other imaging modalities when assessing dizziness and are less dependent on immediate head CT scans on initial patient arrival. This trend corroborates a previous study that demonstrated obtaining head MRI scans appear to be more sensitive in highlighting an abnormality than head CT scans in patients who present to the ED with a complaint of dizziness [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Interestingly, during this same time, the overall utilization of head CT scans in the ED have increased by 69% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This discrepancy may indicate that ED physicians have become more confident and precise in their diagnostic approach in patients presenting with dizziness.\u003c/p\u003e \u003cp\u003eThe lack of a significant change in the number of diagnoses provided for dizziness cases, along with the high variability in concluded diagnoses, highlights the diagnostic challenge that dizziness presents in the ED. Dizziness is a symptom with a wide range of potential causes, and arriving at a definitive diagnosis can be challenging [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This finding underscores the need for continued research and development of clinical decision support tools to assist clinicians in identifying the underlying cause of dizziness more efficiently.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eSome limitations arise from the NHAMCS data source that was used to accomplish this study. First, the RFV code of interest was listed under the classification of \u0026ldquo;vertigo-dizziness\u0026rdquo;. These two terms are not synonymous and thus the data source prevented us from attributing all of the cases to one or another. This is an important distinction because symptoms of vertigo are more likely to be a manifestation of otologic or neurologic etiologies, which may warrant a differing diagnostic pathway than pure dizziness [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Second, although there was data on whether a head CT was ordered during the ED encounter, there was no data on the utilization of a head MRI. Thus, it was not possible to compare changes in utilization between the two imaging modalities.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides valuable insights into the trends and characteristics of ED visits for dizziness over a decade. The significant increase in such visits emphasizes the need for improved strategies for evaluating and managing dizziness in the ED. Tailoring interventions to specific age groups and addressing potential gender disparities in healthcare-seeking behavior are areas that warrant further investigation. Additionally, the development of more accurate and efficient diagnostic tools for dizziness should be a priority to enhance patient care, improve clinician assessments, and reduce healthcare costs.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. \u003cem\u003eArch Intern Med\u003c/em\u003e. 1993;153(21):2474-2480.\u003c/li\u003e\n\u003cli\u003eAgrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004 [published correction appears in Arch Intern Med. 2009 Aug 10;169(15):1419]. \u003cem\u003eArch Intern Med\u003c/em\u003e. 2009;169(10):938-944. doi:10.1001/archinternmed.2009.66\u003c/li\u003e\n\u003cli\u003eKerber KA, Callaghan BC, Telian SA, et al. Dizziness Symptom Type Prevalence and Overlap: A US Nationally Representative Survey. \u003cem\u003eAm J Med\u003c/em\u003e. 2017;130(12):1465.e1-1465.e9. doi:10.1016/j.amjmed.2017.05.048\u003c/li\u003e\n\u003cli\u003eDunlap PM, Khoja SS, Whitney SL, Freburger JK. Assessment of Health Care Utilization for Dizziness in Ambulatory Care Settings in the United States. \u003cem\u003eOtol Neurotol\u003c/em\u003e. 2019;40(9):e918-e924. doi:10.1097/MAO.0000000000002359\u003c/li\u003e\n\u003cli\u003eB\u0026ouml;sner S, Schwarm S, Grevenrath P, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care - a systematic review. \u003cem\u003eBMC Fam Pract\u003c/em\u003e. 2018;19(1):33. Published 2018 Feb 20. doi:10.1186/s12875-017-0695-0\u003c/li\u003e\n\u003cli\u003eNewman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. \u003cem\u003eMayo Clin Proc\u003c/em\u003e. 2008;83(7):765-775. doi:10.4065/83.7.765\u003c/li\u003e\n\u003cli\u003eNewman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. \u003cem\u003eMayo Clin Proc\u003c/em\u003e. 2007;82(11):1329-1340. doi:10.4065/82.11.1329\u003c/li\u003e\n\u003cli\u003eGoeldlin M, Gaschen J, Kammer C, et al. Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag. \u003cem\u003eJ Neurol\u003c/em\u003e. 2019;266(12):3076-3086. doi:10.1007/s00415-019-09525-4\u003c/li\u003e\n\u003cli\u003eAhsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. \u003cem\u003eLaryngoscope\u003c/em\u003e. 2013;123(9):2250-2253. doi:10.1002/lary.23798\u003c/li\u003e\n\u003cli\u003eSaber Tehrani AS, Coughlan D, Hsieh YH, et al. Rising annual costs of dizziness presentations to U.S. emergency departments. \u003cem\u003eAcad Emerg Med\u003c/em\u003e. 2013;20(7):689-696. doi:10.1111/acem.12168\u003c/li\u003e\n\u003cli\u003eKerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. \u003cem\u003eAcad Emerg Med\u003c/em\u003e. 2008;15(8):744-750. doi:10.1111/j.1553-2712.2008.00189.x\u003c/li\u003e\n\u003cli\u003eCenter for Disease Control and Prevention. National Center for Health Statistics. About the Ambulatory Health Care Surveys. 2019. Available online: https://www.cdc.gov/nchs/ahcd/about_ahcd.htm#NHAMCS.\u003c/li\u003e\n\u003cli\u003eCenter for Disease Control and Prevention. National Center for Health Statistics. Scope and Sample Design. 2015. Available online: https://www.cdc.gov/nchs/achd/achd_scope/htm.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. National Center for Health Statistics. Ambulatory Health Care Data. 2022. Available online: https://www.cdc.gov/nchs/acdh/index.htm.\u003c/li\u003e\n\u003cli\u003eSchneider D, Appleton L, McLemore T. A reason for visit classification for ambulatory care. \u003cem\u003eVital Health Stat 2\u003c/em\u003e. 1979;(78):i-63.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. National Center for Health Statistics. 2019 NHAMCS Micro-data File Documentation. 2019. Available online: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc19-ed-508.pdf.\u003c/li\u003e\n\u003cli\u003eFilippopulos FM, Albers L, Straube A, et al. 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The utility of brain CT scan modality in the management of dizziness at the emergency department: A retrospective single-center study. \u003cem\u003eAnnals of medicine and surgery (2012)\u003c/em\u003e, \u003cem\u003e64\u003c/em\u003e, 102220. https://doi.org/10.1016/j.amsu.2021.102220\u003c/li\u003e\n\u003cli\u003eElHabr A, Merdan S, Ayer T, et al. Increasing Utilization of Emergency Department Neuroimaging From 2007 Through 2017. \u003cem\u003eAJR Am J Roentgenol\u003c/em\u003e. 2022;218(1):165-173. doi:10.2214/AJR.21.25864\u003c/li\u003e\n\u003cli\u003eGoeldlin M, Gaschen J, Kammer C, et al. Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag. \u003cem\u003eJ Neurol\u003c/em\u003e. 2019;266(12):3076-3086. doi:10.1007/s00415-019-09525-4\u003c/li\u003e\n\u003cli\u003eJung I, Kim JS. Approach to dizziness in the emergency department. \u003cem\u003eClin Exp Emerg Med\u003c/em\u003e. 2015;2(2):75-88. Published 2015 Jun 30. doi:10.15441/ceem.15.026\u003c/li\u003e\n\u003cli\u003eDella-Morte D, Rundek T. Dizziness and vertigo. \u003cem\u003eFront Neurol Neurosci\u003c/em\u003e. 2012;30:22-25. doi:10.1159/000333379\u003c/li\u003e\n\u003cli\u003eNeuhauser HK. The epidemiology of dizziness and vertigo. \u003cem\u003eHandb Clin Neurol\u003c/em\u003e. 2016;137:67-82. doi:10.1016/B978-0-444-63437-5.00005-4\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Drexel University College of Medicine","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"dizziness, vertigo, emergency department, presentation, healthcare utilization","lastPublishedDoi":"10.21203/rs.3.rs-4410707/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4410707/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDizziness is common reason for visit to the emergency department (ED), which impacts patient well-being and places significant demands on healthcare resources. Despite its prevalence, the trends of patient presentation and healthcare utilization has not been assessed for decades.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eObjectives\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTo comprehensively analyze 10-year trends of patient presentation and healthcare utilization of dizziness attributed visits to the ED.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMethods\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe National Hospital Ambulatory Medical Care Survey (NHAMCS) was used to obtain data for patients that visited the emergency department for dizziness from 2010 to 2019. Nationally representative estimates were derived for patient demographics and diagnostics. Trend analyses were conducted to investigate potential patterns and implications.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eResults\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA total of 1.3 billion dizziness attributed ED visits were estimated from 2010 to 2019 with a significant increase per year and a 49.23% increase over the decade (p\u0026lt;.001). Diagnostic imaging has significantly increased for this population (p=.005). However, the amount of head CT scans ordered have remained stable (p=.201). The number of medications provided during these visits have significantly increased (p=.005), without any difference in the rate of being admitted to the hospital (p=.231).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusion\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe rate of ED visits attributed to dizziness has continued to rise in the recent decade. There are notable presentation rates for ED dizziness visits depending on patient age, sex, and race. Although overall utilization of imaging has increased, orders for head CT has remained stable.\u003c/p\u003e","manuscriptTitle":"Ten Year Trends of Dizziness in the Emergency Department","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 20:59:16","doi":"10.21203/rs.3.rs-4410707/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"19c029a2-205e-48f4-88dc-3284f3717744","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":31829185,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2024-05-14T20:59:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-14 20:59:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4410707","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4410707","identity":"rs-4410707","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}