Implementation of a treatment algorithm incorporating a targeted clinical examination for acute dizziness in a neurology department was associated with reduced resource use (apart from a small increase in the use of CT) and improved diagnostic accuracy.
Key Findings
Results
MRI use decreased significantly among patients discharged with dizziness as the primary diagnosis after algorithm implementation.
MRI use decreased from 34.7% (before implementation) to 24.5% (after implementation)
This decrease was described as statistically significant
The study period covered 2015–2023, divided into three phases: before (2015–17), during (2018–20), and after (2021–23) implementation
Data were collected retrospectively from all patients admitted to the Department of Neurology at Akershus University Hospital in Norway
Results
CT use increased significantly among patients discharged with dizziness as the primary diagnosis after algorithm implementation.
CT use increased from 87.5% (before) to 90.9% (after implementation)
This increase was described as statistically significant
The authors noted this as a small increase and characterized it as the one exception to the general pattern of reduced resource use
Results
Assessment by an otolaryngologist decreased significantly after algorithm implementation.
Otolaryngologist assessment decreased from 21.5% (before) to 6.8% (after implementation)
This decrease was described as statistically significant
This represents a reduction of approximately two-thirds in otolaryngology consultations
Results
The proportion of patients discharged with a specific diagnosis of dizziness increased substantially after algorithm implementation.
The proportion with a specific dizziness diagnosis increased from 20% (before implementation) to 34% (after implementation)
This was interpreted as evidence of improved diagnostic accuracy
The targeted clinical examination included positional tests, assessment of gaze stability, nystagmus, and vertical ocular misalignment
Results
Length of hospital stay showed a small, non-significant reduction in the dizziness group, contrasting with a statistically significant increase in the reference group.
The reduction in length of stay among dizziness patients was described as 'small' and non-significant
The reference group showed a statistically significant increase in length of stay over the same period
This divergence suggests the algorithm may have partially buffered against the general trend of increasing hospital stay lengths
Background
The treatment algorithm was designed to distinguish between central and peripheral causes of acute dizziness using a targeted clinical examination.
The algorithm incorporated positional tests and assessment of gaze stability, nystagmus, and vertical ocular misalignment
Acute dizziness frequently leads to hospital admission due to suspected stroke
The targeted clinical examination is described as 'a well-documented tool for distinguishing between central and peripheral causes'
Implementation was carried out at the Department of Neurology at Akershus University Hospital in Norway
What This Means
This research suggests that introducing a structured examination protocol for patients admitted to a neurology department with sudden dizziness can lead to more efficient and accurate care. The protocol focused on bedside tests — including checks for abnormal eye movements and positional maneuvers — to help doctors determine whether dizziness was coming from the brain (a potentially serious cause like stroke) or from the inner ear (a less dangerous cause). After this protocol was introduced at a Norwegian hospital, doctors ordered fewer MRI scans and far fewer ear-nose-throat specialist consultations, while the proportion of patients leaving the hospital with a clear, specific diagnosis of their type of dizziness rose from about 1 in 5 to about 1 in 3.
The study also found that while hospital stay lengths were creeping upward for other neurological patients over the same time period, they remained relatively stable for dizziness patients — suggesting the protocol may have helped prevent unnecessary prolonged admissions. CT scanning increased slightly, which the researchers noted as the one area of increased resource use.
This research suggests that training neurologists to perform a targeted physical examination for dizziness — rather than relying heavily on brain imaging and specialist referrals — may help hospitals use resources more efficiently while also giving patients clearer answers about what is causing their symptoms. Because the study was retrospective and conducted at a single hospital, further research across multiple sites would be needed to confirm how broadly these findings apply.
Paulsen A, Søby L, Barra M, Lurås H, Rønning O. (2026). Acute dizziness - resource use and diagnosis with targeted clinical examination.. Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. https://doi.org/10.4045/tidsskr.25.0446