Imaging for Nonspecific Dizziness in the Emergency Department is Associated With Delayed Time to First Otolaryngology Evaluation

OBJECTIVE: To identify differences in time to first otolaryngology evaluation for patients presenting to the emergency department (ED) with nonspecific dizziness. STUDY DESIGN: Retrospective cohort study between 2015 and 2024. SETTING: Single tertiary care academic center. METHODS: Patients with International Classification of Disease code R42 (dizziness and giddiness) during their ED visit who later were seen by otolaryngologists in the outpatient setting were grouped based on whether imaging was received in the emergency department. Demographic characteristics were analyzed. The median time to otolaryngology evaluation and the diagnoses rendered by otolaryngology were assessed. RESULTS: Of the 2272 patients seen in the ED for dizziness and who subsequently followed up with otolaryngology, imaging was obtained at the initial ED visit in 580 patients (25.5%). The most common imaging modalities were CT brain (415, 18.3%), MRI brain (291, 12.8%), and CT head and neck (139, 6.1%). Patients were first seen by otolaryngology at a median (Q1, Q3) of 26.6 (4.4, 119.1) weeks after their index ED visit. Patients who required imaging had a significantly longer median time to evaluation of 74.9 weeks (12.7, 175.7), compared to 16.5 weeks (3.6, 90.4) for patients who did not require imaging (P < .001). The most common diagnoses at the time otolaryngology evaluation included benign paroxysmal positional vertigo (299, 13.2%), migraine (98, 4.3%), vestibular neuritis (66, 2.9%), and Ménière's disease (61, 2.7%). CONCLUSION: Dizzy patients receiving imaging in the ED may experience delays in otolaryngology evaluation, potentially predisposing them to increased morbidity and contributing to high healthcare costs.