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Effectiveness and reliability of the four‐step STANDING algorithm performed by interns and senior emergency physicians for predicting central causes of vertigo

Effectiveness and reliability of the four‐step STANDING algorithm performed by interns and senior... INTRODUCTIONBackgroundAcute vertigo, loss of balance, and unsteadiness are common chief complaints reported by about 4% of patients visiting emergency departments (ED).1 In a symptom‐quality paradigm, emergency physicians (EPs) commonly encounter two clinical settings: the acute and the episodic vestibular syndromes (AVS and EVS).2,3 Benign paroxysmal positional vertigo (BPPV) is the leading cause of EVS,4,5 and posterior circulation strokes must be adequately differentiated from vestibular neuritis as they concerned 15% of AVS.6 Given the concern for stroke, EPs are challenged from a diagnostic and a management standpoint: relying on reliable clinical features, deciding adequately either to perform or to defer neuroimaging, and either referring patients to an otologist consultation or admitting them in the neurology department. Without a reliable clinical approach due to lack of learning about vestibular conditions,7 this dilemma could lead to overuse neuroimaging in benign disorders. However, brain computed tomography (CT) is commonly available around the clock, but very insensitive at detecting posterior ischemic strokes (28.5%).8,9 Brain magnetic resonance diffusion‐weighted imaging (MRI‐DWI) is the then criterion standard diagnostic examination, but it is less available and may also miss one in five small ischemic strokes within 48 h after symptoms onset (up to 53%).10,11In the emergency setting, all these http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Academic Emergency Medicine Wiley

Effectiveness and reliability of the four‐step STANDING algorithm performed by interns and senior emergency physicians for predicting central causes of vertigo

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References (45)

Publisher
Wiley
Copyright
Copyright © 2023 Society for Academic Emergency Medicine
ISSN
1069-6563
eISSN
1553-2712
DOI
10.1111/acem.14659
Publisher site
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Abstract

INTRODUCTIONBackgroundAcute vertigo, loss of balance, and unsteadiness are common chief complaints reported by about 4% of patients visiting emergency departments (ED).1 In a symptom‐quality paradigm, emergency physicians (EPs) commonly encounter two clinical settings: the acute and the episodic vestibular syndromes (AVS and EVS).2,3 Benign paroxysmal positional vertigo (BPPV) is the leading cause of EVS,4,5 and posterior circulation strokes must be adequately differentiated from vestibular neuritis as they concerned 15% of AVS.6 Given the concern for stroke, EPs are challenged from a diagnostic and a management standpoint: relying on reliable clinical features, deciding adequately either to perform or to defer neuroimaging, and either referring patients to an otologist consultation or admitting them in the neurology department. Without a reliable clinical approach due to lack of learning about vestibular conditions,7 this dilemma could lead to overuse neuroimaging in benign disorders. However, brain computed tomography (CT) is commonly available around the clock, but very insensitive at detecting posterior ischemic strokes (28.5%).8,9 Brain magnetic resonance diffusion‐weighted imaging (MRI‐DWI) is the then criterion standard diagnostic examination, but it is less available and may also miss one in five small ischemic strokes within 48 h after symptoms onset (up to 53%).10,11In the emergency setting, all these

Journal

Academic Emergency Medicine – Wiley

Published: May 1, 2023

Keywords: emergency department; eye movements; magnetic resonance imaging; validation study; vertigo

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