Dizziness in the Emergency Department: A Population-Based Project

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DESCRIPTION (provided by applicant): Dizziness is among the most common principal complaints in the ambulatory care setting. Recent advances significantly improve the ability to diagnose and treat common causes of dizziness but this information may not be adequately disseminated to frontline physicians or training directors because specialists in dizziness are not common. As a result, deficiencies and inefficiencies are likely to be prevalent, perhaps ubiquitous, but no large population-based study has focused on evaluating this important issue. Often patients undergo extensive evaluations searching for central nervous system etiologies while a benign peripheral vestibular disorder goes untreated, or conversely a benign disorder is assumed when an early severe disorder is the cause. Therefore, burden of illness and healthcare utilization may be unnecessarily high in patients with dizziness, but these important measures also have not been determined in population-based studies. These factors are critical in determining the impact of an illness which the NIH has declared a priority. The emergency department (ED) is an appropriate setting to focus initial efforts because dizziness is common in the ED and efforts to improve ED overcrowding are desperately needed. Utilizing patients identified in an established, NIH funded, population-based study, the Brain Attack Surveillance In Corpus Christi (BASIC) project, we hypothesize that .0ed and that burden of illness and healthcare utilization are high among these patients. In a future R01 application, addressing the important findings of this study may improve quality of care, decrease healthcare expenditures, and decrease ED overcrowding. The BASIC project has demonstrated success in recruiting large numbers of subjects and involves long-term collaboration with the community and local Public Health Department. The candidate is a neurologist fellowship trained in neuro-otology, dedicated to a career in patient- oriented research. This application proposes a 5-year plan, including formal training through the K30 NIH Clinical Research Training program at the University of Michigan, to develop the candidate into an independent clinical researcher. This K30 program includes a core curriculum, individualized scientific advisory committee, and small group seminars on focused areas of research. Superb resources of a top public university and mentors with demonstrated success in fostering careers focused on key elements of this and future projects makes the University of Michigan an ideal environment for the candidate. Relevance: Identifying deficiencies in care is critical to improving quality of care, reducing healthcare expenditures, and decreasing ED overcrowding.