Abstract Details

Title US National Trends in Imaging Utilization and Medication Treatments for Dizziness in Ambulatory Care Settings

Topic Practice, Policy, and Ethics

Presentation(s) Practice, Policy, and Ethics Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 008

Objective To investigate long-term trends in management of dizziness using a nationally-representative database.

Background Diagnosis and treatment of dizziness in ambulatory care remains challenging.

Design/Methods We analyzed trends in national rates of imaging (computed tomography [CT] scans, magnetic resonance imaging [MRI]) and meclizine, glucocorticoid prescriptions from 1995-2015. We used the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey (NAMCS), which analyzes a weighted sample of US primary care data and office-based practices every year and provides a weighting algorithm for systematic extrapolation to national estimates. The dizziness group included patients >16 years-old with vertigo/dizziness recorded as a reason-for-visit, or a coded final encounter diagnosis of either the symptom dizziness (ICD-9-CM 780.4) or any inner ear vestibular disorder (ICD-9-CM 386.x).

Results The weighted estimate was 239.8 million patients with dizziness. The dizziness group was 62% female with median age 61 (IQR: 45-75). CT utilization rates rose from 1.5% in 1995 to 8.5% in 2008, then fell to 1.2% by 2015. MRI rates rose from 3.6% in 1995 to 8.4% in 2006, then fell to 3.2% by 2015. Imaging rates (CT or MRI) were 4.4% (MRI:CT ratio 0.39) in acute peripheral vestibulopathy (APV) and 2.9% (MRI:CT ratio 3.9) in benign paroxysmal positional vertigo (BPPV). Nearly 20% of both BPPV and APV-diagnosed cases received meclizine treatment. Corticosteroids were used in 4.6% of APV-diagnosed cases.

Conclusions Imaging utilization in ambulatory care settings for dizzy patients rose from 1995 to 2008, then fell precipitously. This could reflect the effects of the 2008 US financial crisis, new payment models, or some other cause for change in diagnostic practices. That rates of imaging and meclizine treatment among those diagnosed as BPPV are similar to both the total population of dizzy patients and those diagnosed as APV suggesting poor adherence to clinical practice guideline recommendations for BPPV.

Authors/Disclosures
Shervin Badihian, MD (Cleveland Clinic) PRESENTER	Dr. Badihian has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
David E. Newman-Toker, MD, PhD, FAAN (Johns Hopkins Unversity School of Medicine, Dept of Neurology)	The institution of Dr. Newman-Toker has received research support from NIH, AHRQ, AHA, Moore Foundation. Dr. Newman-Toker has received intellectual property interests from a discovery or technology relating to health care.
Ali Saber Tehrani, MD (Johns Hopkins University School of Medicine)	Dr. Saber Tehrani has nothing to disclose.

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