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ObjectivesWe aimed to determine the frequency of vestibular syndromes, diagnoses, diagnostic errors and resources used in patients with dizziness in the emergency department (ED).DesignRetrospective cross-sectional study.SettingTertiary referral hospital.ParticipantsAdult patients presenting with dizziness.Primary and secondary outcome measuresWe collected clinical data from the initial ED report from July 2015 to August 2020 and compared them with the follow-up report if available. We calculated the prevalence of vestibular syndromes and stroke prevalence in patients with dizziness. Vestibular syndromes are differentiated in acute (AVS) (eg, stroke, vestibular neuritis), episodic (EVS) (eg, benign paroxysmal positional vertigo, transient ischaemic attack) and chronic (CVS) (eg, persistent postural-perceptual dizziness) vestibular syndrome. We reported the rate of diagnostic errors using the follow-up diagnosis as the reference standard.ResultsWe included 1535 patients with dizziness. 19.7% (303) of the patients presented with AVS, 34.7% (533) with EVS, 4.6% (71) with CVS and 40.9% (628) with no or unclassifiable vestibular syndrome. The three most frequent diagnoses were stroke/minor stroke (10.1%, 155), benign paroxysmal positional vertigo (9.8%, 150) and vestibular neuritis (9.6%, 148). Among patients with AVS, 25.4% (77) had stroke. The cause of the dizziness remained unknown in 45.0% (692) and 18.0% received a false diagnosis. There was a follow-up in 662 cases (43.1%) and 58.2% with an initially unknown diagnoses received a final diagnosis. Overall, 69.9% of all 1535 patients with dizziness received neuroimaging (MRI 58.2%, CT 11.6%) in the ED.ConclusionsOne-fourth of patients with dizziness in the ED presented with AVS with a high prevalence (10%) of vestibular strokes. EVS was more frequent; however, the rate of undiagnosed patients with dizziness and the number of patients receiving neuroimaging were high. Almost half of them still remained without diagnosis and among those diagnosed were often misclassified. Many unclear cases of vertigo could be diagnostically clarified after a follow-up visit.

Schwindelerkrankungen in einem tertiären HNO-NotfallzentrumSchwindel ist eines der häufigsten Symptome in der HNO-Notfallstation, trotzdem wird ein Viertel dieser Patienten ohne Diagnose entlassen. Viele erhalten eine unnötige Bildgebung. Eine adäquate Einteilung in Schwindelsyndrome erlaubt das Eingrenzen der Differenzialdiagnosen und ermöglicht damit eine angemessene Diagnostik sowie Therapie. In diesem Beitrag werden die Häufigkeiten der Diagnosen, deren Begleitsymptome und die angewandte Diagnostik dargestellt. Eine akkurate Dokumentation von Augenbewegungen, das Durchführen von "HINTS" (Head Impulse -Nystagmus -Test of Skew) und Lagerungsmanövern gehören zum täglichen Handwerk jedes HNO-Arztes und Notfallmediziners. Schwindel ist einer der häufigsten Gründe für einen Arztbesuch [17]. Dennoch wird in 40-80 % der Fälle keine erklärende Diagnose gestellt [25]. Eine systematische Überprüfung der aktuellen Studienlage von 2014 zeigte, dass die Lebenszeitprävalenzen für ungerichteten Schwindel zwischen 17 und 30 % und für gerichteten Schwindel zwischen 3 und 10 % liegen [22]. Die große Streubreite widerspiegelt die Problema-L. Comolli und M. Goeldlin: Geteilte Erstautorenschaft. U. Fischer und G. Mantokoudis: Geteilte Letzautorenschaft.