Predictors of vertigo in the emergency department: The preved study

Mandge, Vishal; Palaiodimos, Leonidas; Lai, Qingying; Papanastasiou, Christos A.; Wang, Yanjun; Santos, Daniel; Grau, Luis; Kodali, Alimitha; Ocava, Lenore; Gutwein, Andrew H

doi:10.1016/j.jstrokecerebrovasdis.2020.105043

Cited by 9 publications

(26 citation statements)

References 31 publications

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“…Second, some patients with headache, head trauma, anxiety, and depression might be unwilling to be hospitalized for further diagnosis and treatment. This was different from otolaryngology and the emergency department (Ljunggren et al., 2018 ; Mandge et al., 2020 ; Yardley et al., 1998 ).…”

Section: Discussionmentioning

confidence: 91%

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Dizziness in a tertiary neurological department: A cross‐sectional study

Shen

2022

Brain and Behavior

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Background and objective: Dizziness is a common and challenging symptom, which can be caused by different pathophysiological mechanisms and might affect a large number of population. However, up to now, there have been limited research on the characteristics of dizziness as the chief complaint in hospitalized patients in the Department of Neurology. Thus, the aim of this study was to investigate the hospitalized patients with dizziness as their chief complaint in the Department of Neurology. Methods:In this cross-sectional study, we conducted a retrospective document analysis of hospitalized patients admitted to a tertiary neurological department with the symptom of dizziness during the period of September 2019 to December 2020. We included 211 patients with dizziness as their chief complaint from 1841 patients admitted to this tertiary neurological department during that period.Results: Of all 1841 hospitalized patients, those with dizziness as the chief complaint accounted for 11.5% and most of their past medical history included hypertension, diabetes, cerebrovascular diseases, dyslipidemia, and coronary heart disease. Among these 211 patients, dizziness was more common in women than in men (p = .004). More patients presented with vertigo (40.8%) and light-headedness (39.8%) than disequilibrium (17.1%) and pre-syncope (2.4%). Nausea (48.3%), vomiting (34.1%), headache (13.3%), walking unsteadily (13.3%), and ear symptoms (12.8%) were the most common concomitant symptoms. Dix-Hallpike test (24.6%) and Romberg's sign (11.4%) were positive in these dizzy patients. Nystagmus (2.4%), vision changes (1.4%), and hearing disorders (8.5%) were relatively rare symptoms. Common auxiliary examinations were performed, such as magnetic resonance imaging (60.2%), computed tomography (31.8%), carotid duplex ultrasound (30.8%), and echocardiography (28.0%). Benign paroxysmal positional vertigo (24.2%) and stroke/transient ischemic attack (19.0%) were confirmed to be common causes of dizziness. Note that 97.2% of dizzy patients were in improved recovery after treatment.

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Section: Discussionmentioning

confidence: 91%

“…This was different from otolaryngology and the emergency department (Ljunggren et al, 2018;Mandge et al, 2020;Yardley et al, 1998).…”

Section: Discussionmentioning

confidence: 95%

Dizziness in a tertiary neurological department: A cross‐sectional study

Shen

2022

Brain and Behavior

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“…There were two papers that were included in a previous meta-analyses but full text in English could not be obtained for one paper [15] and the 2 × 2 data could not be verified for the second paper [16]. Preliminary 2 × 2 data were obtainable on three studies [16][17][18], but due to ambiguity in published results, these were not included in the final analysis.…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of the Use of Head Impulse Test and Head Impulse Test with Direction Changing Nystagmus and Test of Skew Deviation in the Diagnosis of Peripheral Vertigo and Stroke

et al. 2022

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Introduction: The head impulse test (HIT) and HIT combined with direction-changing Nystagmus-Test of Skew deviation (HINTS) have been proposed as bedside tests to differentiate between peripheral and central causes of vertigo in the emergency department (ED). We conducted a meta-analysis of the HIT and HINTS tests to diagnose peripheral vertigo (PV) and central vertigo. Methods: Pubmed, Google Scholar, EmBase, and articles references published in English up to July 2021 were searched for keywords “vertigo” or “acute vestibular syndrome” or “dizziness” and “head impulse” and “stroke.” The bivariate method for meta-analysis was used to calculate positive (PLR) and negative likelihood ratios (NLR) and summary receiver operating characteristics area under the curve (AUC). Results: A total of 11 studies were included analysing both HIT (8 studies, N = 417) and HINTS (6 studies, N = 405). HIT and HINTS were performed within 24 h in 4 of 11 studies. PLR and NLR for HIT in PV was 4.85 (95% CI: 2.83–8.08) and 0.19 (95% CI: 0.12–0.29, I2 63.25%), respectively. The AUC for HIT the diagnosis of PV and stroke was 0.90 and 0.92, respectively. PLR and NLR for a negative HIT in stroke was 5.85 (95% CI: 3.07–10.6) and 0.17 (95% CI: 0.08–0.30), respectively. PLR and NLR for peripheral HINTS pattern for PV was 17.3 (95% CI: 8.38–32.1) and 0.15 (95% CI: 0.07–0.26), respectively. PLR and NLR for central HINTS pattern for stroke: 5.61 (95% CI: 4.19–7.7) and 0.06 (95% CI: 0.03–0.12). In all included studies, HIT and HINTS exams were administered by neurology residents or neurology specialists with additional neuro-otology or neuro-ophthalmology subspeciality experience, and two studies included ED physicians. Raters reported high degree of bias and high concern regarding applicability in most domains of the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Meta-regression did not demonstrate a statistically significant effect of publication year, time to test, and type of assessor on sensitivity or false positive rate. Conclusion: The HIT and HINTS exams appear to be moderately good discriminators of central and PV. However, in most papers, the tests were administered by neurologists and were evaluated beyond 24 h, which may limit utility in the ED setting.

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“…This was different from otolaryngology and the emergency department. [10][11][12] Some signs can often be found in physical examination and auxiliary examination in patients with dizziness. Neurological defect symptoms were most common positive sign in patients with dizziness.…”

Section: Discussionmentioning

confidence: 99%

Dizziness In A Tertiary Neurological Department： A Retrospective Study

Shen

2021

Preprint

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Background Dizziness is a common and challenging condition among population. There is little published study which surveys the characteristics of dizziness of inpatients in the department of neurology. Objective This study was to investigate the inpatients with dizziness as the chief complaint in a neurology department. Materials and Methods We conducted a retrospective study of inpatients with dizziness attending a tertiary neurological department in Beijing. We audited 211 patients with dizziness as the chief complaint from 1841 patients discharged from our tertiary neurological department. Results The inpatients with dizziness as the chief complaint accounted for 11.5% of all inpatients. Dizziness was more common in women than in men (p=0.004). There were more patients presenting with vertigo (40.8%) and light-headedness (39.8%) than disequilibrium (17.1%) and pre-syncope (2.4%). Nausea (48.3%), vomiting (34.1%), headache (13.3%), walk unsteadily (13.3%) and ear symptoms (12.8%) were the most common accompanying symptoms. Hypertension, diabetes, cerebrovascular diseases, dyslipidemia, and coronary heart disease were the most common diseases in past medical history. Dix-Hallpike test (24.6%) and Romberg’s sign (11.4%) were positive in dizziness patients. Nystagmus (2.4%), vision changes (1.4%) and hearing disorders (8.5%) were relatively rare symptoms. MRI (60.2%), CT (31.8%), carotid duplex ultrasound (30.8%), echocardiography (28.0%) were common auxiliary examination. Benign paroxysmal positional vertigo (24.2%) and stroke/transient ischemic attack (19.0%) were common causes of dizziness. 97.2% of inpatients with dizziness can be improving after treatment. Conclusion Dizziness was a common and challenging condition. Vertigo and light-headedness were the most common dizziness types. Benign paroxysmal positional vertigo and stroke/transient ischemic attack were the common dizziness disorders. The prognosis of most patients with dizziness was good.

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Predictors of vertigo in the emergency department: The preved study

Cited by 9 publications

References 31 publications

Dizziness in a tertiary neurological department: A cross‐sectional study

Dizziness in a tertiary neurological department: A cross‐sectional study

Meta-Analysis of the Use of Head Impulse Test and Head Impulse Test with Direction Changing Nystagmus and Test of Skew Deviation in the Diagnosis of Peripheral Vertigo and Stroke

Dizziness In A Tertiary Neurological Department： A Retrospective Study

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