A Retrospective Audit of Emergency Department Management of Acute Dizziness and Vertigo in New Zealand: Evaluating Alignment to Evidence-based Guidelines and the Impact of Physiotherapist Involvement

Abstract

Acute dizziness and vertigo are common but diagnostically challenging presentations in emergency departments (EDs), with known risks of misdiagnosis and variability in care. Despite advances in diagnostic approaches, the extent to which evidence-based assessment and management are applied in routine clinical practice remains uncertain, particularly within the Aotearoa New Zealand context.

This study aimed to evaluate the quality and equity of care for patients presenting with acute dizziness and vertigo in two metropolitan EDs and to examine the contribution of ED physiotherapy to clinical practice. A mixed-methods design was employed, consisting of a rapid scoping review of evidence-based vestibular assessment and a retrospective clinical audit of emergency physician and physiotherapy documentation. A disproportionate stratified sampling approach was used to enhance representation of Māori patients and support equity analysis.

Overall adherence to evidence-based care was low across both diagnostic and management domains. Structured vestibular assessments were infrequently documented, and treatment approaches were often inconsistent with clinical guidelines. Physiotherapy involvement was associated with higher rates of evidence-based assessment and intervention. Māori patients received slightly lower rates of evidence-aligned care and had reduced access to physiotherapy services compared to non-Māori.

These findings highlight a gap between recommended and actual clinical practice and identify variation in access to specialised assessment. The study provides novel local evidence on emergency vestibular care, including Indigenous health data, and supports the need for system-level approaches to improve consistency, clinical quality, and equity in ED care pathways.