ORIGINAL ARTICLEOverreliance on Symptom Quality in Diagnosing Dizziness: Results of a Multicenter Survey of Emergency Physicians
Section snippets
PARTICIPANTS AND METHODS
We conducted a multicenter, anonymous, Web-based survey of EPs from September 1, 2006, to November 3, 2006. The study was developed and implemented at Johns Hopkins University, in collaboration with the Emergency Medicine Network (www.emnet-usa.org). The survey was approved by the human subjects committees at all participating institutions, with consent waived.
All EM resident and attending EPs at 17 hospitals affiliated with 5 academic centers (New York-Presbyterian—The University Hospital of
RESULTS
Of the 505 individuals surveyed, 415 responded for an overall response rate of 82%. Of these 415 respondents, 389 (94%) completed all survey questions. Of the 415 responders, 200 were randomly assigned to survey version A and 215 to version B. Completion rates for versions A and B were not significantly different (91% vs 96%, respectively; P=.36). The median survey duration, including demographic questions, was 5.3 minutes (interquartile range, 4.1-7.3 minutes). The breakdown of demographic
DISCUSSION
Our survey results demonstrate that the quality-of-symptoms approach to dizziness (1) is the dominant diagnostic paradigm in the ED, (2) drives physician thinking and self-reported behaviors at multiple levels, and (3) could be contributing to risky clinical reasoning in the diagnostic assessment of dizziness. These findings are important because recent evidence indicates that the quality-of-symptoms approach appears flawed4 and critical misdiagnosis of dizziness in patients in the ED may be
CONCLUSION
Despite its potential limitations, our study presents strong evidence that the quality-of-symptoms approach is the dominant paradigm for diagnosing acute dizziness among patients in the ED. Furthermore, it suggests that this approach may be displacing alternative diagnostic models, such as those emphasizing other symptom dimensions (eg, timing, triggers, and associated symptoms) to guide diagnostic reasoning. Finally, we have shown significant interindividual variability in physician
Acknowledgments
We thank Elizabeth Elliott, ScD, of the Johns Hopkins Bloomberg School of Public Health for her invaluable help with the survey design and Adam Stubblefield, PhD, of the Department of Computer Science for his help in developing the Web portal to randomly assign participants to the different survey versions.
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This work was presented in poster form at the American College of Emergency Physicians 2007 Annual Meeting; October 8, 2007; Seattle, WA.
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This research was supported principally by the University of California, San Francisco Dean's Summer Fellowship Program (V.A.S.) and by the National Institutes of Health National Center for Research Resources K23 RR17324-01, “Building a New Model for Diagnosis of ED Dizzy Patients” (D.E.N.-T.).