New research from the Kaiser Foundation Hospital in Honolulu suggests head CT is rarely the way to go when treating a patient presenting for dizziness. In fact, only 7.1 percent of those CT scans are yielding meaningful results. In the case of fainting patients, only 6.4 percent had useful CT scans.

Dr. Myles M. Mitsunaga, principal investigator and resident at the John A. Burns School of Medicine, University of Hawaii, and Dr. Hyo-Chun Yoon, radiologist at the Honolulu Kaiser Hospital, told DOTmed News that physicians are under pressure to quickly differentiate between life threatening and benign causes of these symptoms. That may explain why an increasing number of them are jumping the gun to CT imaging.

"Because of the increasing number of patients presenting to the emergency room, the emergency physician faces the additional challenges of time constraints and evaluating more and more patients," said Mitsunaga.
The research indicates head CT scans are only recommended when loss of consciousness is suspected not to be syncope. Using CT in cases of uncomplicated syncope should be avoided unless physical or historical features of CNS dysfunction are present.

Mitsunaga offered us this example:

"Patients presenting with dizziness, who have a history and physical exam of benign paroxysmal positional vertigo, do not require imaging. These patients can be safely sent home to follow up with their primary care physician. On the other hand, patients presenting with dizziness with hearing loss, neurological findings, or unclear causes of dizziness may require imaging for a possible mass or infarction, which require emergent care," said Mitsunaga.

Despite that, use of head CT scans obtained in the emergency department to evaluate patients with syncope appears to be a common practice.

The study, "Head CT Scans in the Emergency Department for Syncope and Dizziness," was published in the January 2015 issue of the American Journal of Roentgenology.

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