From the Guidelines
Most cases of dizziness can be effectively worked up in the outpatient setting, particularly when symptoms are mild to moderate, the patient is hemodynamically stable, and there are no concerning neurological symptoms. The decision to admit a patient for dizziness workup versus outpatient evaluation depends on the severity of symptoms and associated risk factors. According to the most recent study 1, the diagnostic yield of CT remains very low (<1%), whereas the yield of MRI DWI was slightly greater but still low (4%) in patients with isolated dizziness.
Key Considerations for Inpatient Admission
The following factors increase the urgency for inpatient admission:
- Severe, acute dizziness
- Concerning features such as new neurological deficits, altered mental status, inability to walk or maintain hydration, signs of stroke, severe nausea/vomiting, or significant cardiac arrhythmias
- Advanced age
- Recent head trauma
- History of cardiovascular disease
Outpatient Evaluation
Outpatient evaluation typically includes:
- A thorough history and physical examination
- Basic laboratory tests (CBC, electrolytes, glucose)
- Possibly vestibular testing or imaging studies scheduled as needed
As noted in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1, hospital-based evaluation is unlikely to provide benefit in patients with a presumptive cause of reflex-mediated syncope and no other dangerous medical conditions identified. However, inpatient admission is warranted for patients with severe, acute dizziness accompanied by concerning features. This approach balances healthcare resource utilization while ensuring patient safety, as most benign causes of dizziness can be managed effectively as an outpatient, while potentially life-threatening causes require immediate inpatient evaluation and treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Dizziness Workup
Dizziness can be worked up as an inpatient admission or outpatient, depending on the underlying cause and severity of symptoms.
- The differential diagnosis of dizziness can be expansive, but a targeted history and physical examination can often establish a correct diagnosis and appropriate treatment 2.
- Common etiologies of dizziness include hypotension, benign paroxysmal positional vertigo (BPPV), and Meniere disease, which can usually be managed outpatient 2, 3.
- However, if intracranial pathology is suspected, imaging may be indicated, and inpatient admission may be necessary 2.
- Central etiologies, such as strokes and malignancies, often require urgent treatment and may require inpatient admission 4.
Outpatient Management
- BPPV can be treated with a canalith repositioning procedure, such as the Epley maneuver, on an outpatient basis 2, 4.
- Meniere disease can be managed with lifestyle and diet modification, and avoidance of triggers, on an outpatient basis 2, 4.
- Vestibular migraine can be managed with vestibular-suppressive drugs and anticonvulsants, and avoidance of triggers, on an outpatient basis 2, 5.
Inpatient Admission
- Inpatient admission may be necessary if the patient has severe symptoms, such as persistent vertigo, or if there is a suspicion of central etiology, such as stroke or malignancy 4.
- Patients with cardiovascular disease may also require inpatient admission if their dizziness is caused by a cardiovascular condition, such as orthostatic hypotension or myocardial infarction 6.