Tsai Ming-Ta, Chang Kung-Pin, Huang Jyun-Bin, Cheng Shih-Yu, Chiang Charng-Yen, Cheng Fu-Jen
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Township, Kaohsiung County 833.
Department of Emergency Medicine, Kaohsiung Municipal Ta-Tung Hospital, No. 68, Zhonghua 3rd Rd., Qianjin Dist., Kaohsiung City 801.
J Int Med Res. 2020 Sep;48(9):300060520955033. doi: 10.1177/0300060520955033.
Vertigo/dizziness is a common reason for emergency department (ED) visits. Emergency physicians (EPs) must distinguish patients with dizziness/vertigo owing to serious central nervous system (CNS) disorders. We aimed to evaluate the association between physician seniority and use of head computed tomography (CT) and ED length of stay (LOS) in patients presenting to the ED with isolated dizziness/vertigo.
This retrospective cohort study included adult patients with non-traumatic dizziness/vertigo in the ED. EPs were categorized according to seniority: junior (less than 6 years' clinical experience), intermediate (7-12 years), and senior (≥12 years).
Among 2589 patients with isolated dizziness/vertigo, 460 (17.8%) received brain CT; 46 (1.78%) had CNS disorder as a final diagnosis. Junior and intermediate EPs ordered more CT examinations than senior EPs: (odds ratio [OR] = 1.329, 95% confidence interval [CI]: 1.002-1.769 and OR = 1.531, 95% CI: 1.178-2.001, respectively). Patients treated by junior and intermediate EPs had lower patient ED LOS (OR = -0.432, 95% CI: -0.887 to 0.024 and OR = -0.436, 95% CI: -0.862 to -0.011).
We revealed different judgment strategies among senior, intermediate, and junior EPs. Senior EPs ordered fewer CT examinations for patients with isolated vertigo/dizziness but had longer patient LOS.
眩晕/头晕是急诊科就诊的常见原因。急诊医生必须区分因严重中枢神经系统（CNS）疾病导致头晕/眩晕的患者。我们旨在评估医生资历与以孤立性头晕/眩晕就诊于急诊科患者的头部计算机断层扫描（CT）使用情况及急诊科住院时间（LOS）之间的关联。
这项回顾性队列研究纳入了急诊科非创伤性头晕/眩晕的成年患者。急诊医生根据资历进行分类：初级（临床经验少于6年）、中级（7 - 12年）和高级（≥12年）。
在2589例孤立性头晕/眩晕患者中，460例（17.8%）接受了脑部CT检查；46例（1.78%）最终诊断为中枢神经系统疾病。初级和中级急诊医生比高级急诊医生开具更多的CT检查：（优势比[OR]=1.329，95%置信区间[CI]：1.002 - 1.769和OR = 1.531，95% CI：1.178 - 2.001）。由初级和中级急诊医生治疗的患者急诊科住院时间较短（OR = -0.432，95% CI：-0.887至0.024和OR = -0.436，95% CI：-0.862至-0.011）。
我们揭示了高级、中级和初级急诊医生之间不同的判断策略。高级急诊医生为孤立性眩晕/头晕患者开具的CT检查较少，但患者住院时间较长。
