Imprecision in Patient Reports of Dizziness Symptom Quality: A Cross-sectional Study Conducted in an Acute Care Setting

Newman-Toker, David E.; Cannon, Lisa M.; Stofferahn, Matthew E.; Rothman, Richard E.; Yu-Hsiang Hsieh; Zee, David S.
November 2007
Mayo Clinic Proceedings;Nov2007, Vol. 82 Issue 11, p1329
Academic Journal
OBJECTIVE: To quantify precision in patient reports of different attributes of dizziness. PATIENTS AND METHODS: In a cross-sectional study, we interviewed consecutive adult patients with dizziness at 2 urban academic emergency departments (EDs) from July 2, 2005, to August 26, 2005. We excluded patients who were too sick for an interview or who posed a risk to the interviewer. We included those who were ‘dizzy, light-headed, or off-balance’ for 7 days or less or previously ‘bothered’ by the same conditions. We assessed descriptions of dizziness quality elicited by 4 questions in different formats (open-ended, multiresponse, single-choice, and directed). Clarity was assessed qualitatively (vague, circular) and quantitatively (overlap of types of dizziness). Consistency was measured by frequency of mismatched responses across question formats. Reliability was determined by test-retest. RESULTS: Of 1342 patients screened, 872 (65%) were dizzy, light-headed, or off-balance in the past 7 days (n=677) or previously bothered by dizziness (n=195). Among these 872 patients with dizziness, 44% considered dizziness ‘the main reason’ or ‘part of the reason’ for the ED visit. Open-ended descriptions were frequently vague or circular. A total of 62% selected more than 1 dizziness type on the multiresponse question. On the same question, 54% did not pick 1 or more types endorsed previously in open description. Of 218 patients not identifying vertigo, spinning, or motion on the first 3 questions, 70% confirmed ‘spinning or motion’ on directed questioning. Asked to choose the single best descriptor, 52% picked a different response on retest approximately 6 minutes later. By comparison, reports of dizziness duration and triggers were clear, consistent, and reliable. CONCLUSION: Descriptions of the quality of dizziness are unclear, inconsistent, and unreliable, casting doubt on the validity of the traditional approach to the patient with dizziness. Alternative approaches, emphasizing timing and triggers over type, should be investigated.


Related Articles

  • Brush Up on Your HPI Know How and Stay Out of Audit Crosshairs With This Primer.  // ED Coding & Reimbursement Alert;Aug2012, Vol. 14 Issue 8, p57 

    The article discusses coding for the History of Present Illness (HPI) component of evaluation and management (E/M) to ensure audit-free claims. It lists the 7 elements identified by Current Procedural Terminology (CPT®) to be considered when obtaining the HPI. ERcoder, Inc. President Todd...

  • Drill Down to These HPI Element Meanings.  // ED Coding & Reimbursement Alert;Aug2012, Vol. 14 Issue 8, p58 

    The article presents clarifications of the meaning of each of the seven History of Present Illness (HPI) elements as provided by ERcoder, Inc. President Todd Thomas. The elements include location, which is often an anatomic descriptor; quality, or the characteristic of the symptom such as sharp...

  • history-taking. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p383 

    An encyclopedia entry for "history-taking" is presented. It refers to the process by which a doctor gathers information from patients concerning the symptoms of their illnesses and details of previous disorders.

  • The Angry Patient and Family. Izenberg, Neil // Clinical Pediatrics;Oct1992, Vol. 31 Issue 10, p608 

    The article discusses the ways to deal with angry, antagonistic family or patients for obtaining accurate medical history. Confronting these angry individuals may result in inaccurate histories, wasted time, and, ultimately, decreased patient compliance and suboptimal care. In addition, working...

  • Patient Has Explanation for Symptoms? Probe Further!  // ED Legal Letter;Jun2013, Vol. 24 Issue 6, p67 

    The article discusses the requirement to probe further into the condition of a patient by an emergency physician (EP) after hearing the explanation of symptom from the patient. It mentions a 50-year-old man diagnosed incorrectly by an EP for a significant myocardial infarction as a back pain....

  • A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department. Becerra-Camargo, Jesus; Martinez-Martinez, Fernando; Garcia-Jimenez, Emilio // BMC Health Services Research;2013, Vol. 13 Issue 1, p1 

    Background: Admission to an emergency department (ED) is a key vulnerable moment when patients are at increased risk of medication discrepancies and medication histories are an effective way of ensuring that fewer errors are made. This study measured whether a pharmacist-acquired medication...

  • Dizziness.  // Mayo Clinic Health Letter;Apr2014, Vol. 32 Issue 4, p1 

    The article discusses symptoms and management of dizziness. It acknowledges the need to inform a physician about one's encounter with dizziness to determine factors that tend to cause the sensation. It describes prevalence of dizziness in older adults, physiological conditions that maintain...

  • Scabies: a problem that can really get under your skin. Pocock, Helen // Journal of Paramedic Practice;Jan2012, Vol. 4 Issue 1, p8 

    This article explores the assessment, diagnosis and current recommended treatment for scabies in the UK. There are many myths surrounding scabies which could lead to misdiagnosis. Using a case from clinical practice, some of the common features of a history suggestive of infestation are explored...

  • The Many Causes and Treatments of Vertigo.  // Tennessee Tribune;10/23/2014, Vol. 25 Issue 41, p2B 

    The article offers information on the causes, symptoms, and treatments of Vertigo.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics