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Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for GRACE‐3

Diagnostic accuracy of the physical examination in emergency department patients with acute... BACKGROUNDDizziness and vertigo are common symptoms in patients presenting to the emergency department (ED) accounting for 3.3% to 4% of ED visits.1,2 Emergency clinicians must distinguish the majority of patients who will have a benign and self‐limiting etiology of symptoms from the serious causes that can have short‐ and long‐term consequences.3 Dizziness has an heterogeneous presentation and workup, with significant ED resource use, prolonged length of stay,2 and increasing imaging costs overtime. Low‐sensitivity neuroimaging such as noncontrast CT4 is extensively used,5,6 and this represents an opportunity to reduce health care costs. In fact, existing evidence suggests that physical examination maneuvers are more sensitive than MRI early after symptom onset in certain subset of dizzy patients such as those with the acute vestibular syndrome (AVS).7 A good history and physical examination are tools clinicians should use to risk stratify and narrow the differential diagnosis of these patients.3,8–14 The classic teaching focused on the character of dizziness (i.e., “What do you mean by dizzy?”) is associated with misdiagnosis.14,15 The word “dizziness” means different things to different people. Patients have difficulty articulating the symptoms and physicians have difficulty identifying and treating a specific disease responsible for the symptom.16 Dizziness includes lightheadedness, weakness, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Academic Emergency Medicine Wiley

Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for GRACE‐3

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References (106)

Publisher
Wiley
Copyright
Copyright © 2023 Society for Academic Emergency Medicine
ISSN
1069-6563
eISSN
1553-2712
DOI
10.1111/acem.14630
Publisher site
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Abstract

BACKGROUNDDizziness and vertigo are common symptoms in patients presenting to the emergency department (ED) accounting for 3.3% to 4% of ED visits.1,2 Emergency clinicians must distinguish the majority of patients who will have a benign and self‐limiting etiology of symptoms from the serious causes that can have short‐ and long‐term consequences.3 Dizziness has an heterogeneous presentation and workup, with significant ED resource use, prolonged length of stay,2 and increasing imaging costs overtime. Low‐sensitivity neuroimaging such as noncontrast CT4 is extensively used,5,6 and this represents an opportunity to reduce health care costs. In fact, existing evidence suggests that physical examination maneuvers are more sensitive than MRI early after symptom onset in certain subset of dizzy patients such as those with the acute vestibular syndrome (AVS).7 A good history and physical examination are tools clinicians should use to risk stratify and narrow the differential diagnosis of these patients.3,8–14 The classic teaching focused on the character of dizziness (i.e., “What do you mean by dizzy?”) is associated with misdiagnosis.14,15 The word “dizziness” means different things to different people. Patients have difficulty articulating the symptoms and physicians have difficulty identifying and treating a specific disease responsible for the symptom.16 Dizziness includes lightheadedness, weakness,

Journal

Academic Emergency Medicine – Wiley

Published: May 1, 2023

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