Authors: Esraa Jadidi , Asraa Khairallah A Turkistani , Alaa Jadidi , Nouran Mohammed Ali Mohammed

Abstract

Background: Dizziness is a common yet diagnostically challenging complaint in emergency departments (EDs). Although head computed tomography (CT) is widely employed for its evaluation, evidence suggests that it offers limited diagnostic utility. The aim of this study was to evaluate the diagnostic effectiveness of CT scans for patients presenting with dizziness in the ED and to compare CT findings among patients presenting with dizziness, loss of consciousness, and syncope.
Methods: This retrospective, single-center study analyzed electronic medical records of 305 patients who underwent head CT scans at Daryiah Hospital, Riyadh, in 2024. The collected data included patient demographics, clinical presentation, CT findings, and associated costs. Statistical analyses were conducted to assess predictors of abnormal CT results and the financial implications of CT utilization. Of the 305 CT scans performed, 96% yielded normal findings, while only 4% revealed abnormalities.
Results: No statistically significant associations were observed between abnormal CT findings and patient age, sex, or prior medical history. Among patients presenting with dizziness, vertigo, loss of consciousness, or syncope, the diagnostic yield remained uniformly low. Logistic regression analysis confirmed the poor predictive value of clinical variables for detecting abnormal CT outcomes. The cost per abnormal diagnosis was estimated at SAR 26,980.88, underscoring the financial burden associated with low-yield imaging. A projected 20% reduction in CT utilization could result in annual savings of approximately SAR 70,150.
Conclusion: Head CT scans demonstrate a low diagnostic yield in evaluating dizziness-related complaints in the ED and are associated with high costs and limited clinical benefit. These findings support the adoption of more selective imaging protocols that emphasize thorough clinical examination and the use of alternative imaging modalities, such as magnetic resonance imaging, in high-risk cases to enhance diagnostic accuracy and cost-effectiveness.

Keywords: Dizziness, Computed Tomography, Emergency Department, Diagnostic Yield, Cost-Effectiveness, MRI, Syncope, Vertigo.