Dizziness in the Emergency Department: A Population-Based Project

描述（由申请人提供）：头晕是门诊护理中最常见的主诉之一。最近的进展显著提高了诊断和治疗常见头晕原因的能力，但由于头晕专家并不常见，这些信息可能无法充分传播给一线医生或培训主任。因此，不足和效率低下很可能是普遍的，也许是无处不在的，但没有大型的以人口为基础的研究集中在评估这一重要问题。通常患者接受广泛的评估，寻找中枢神经系统的病因，而良性外周前庭

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.