Evaluation of Benign Paroxysmal Positional Vertigo in Primary Health-Care and First Level Specialist Care

Pérez, Paz; Manrique, Covadonga; Alvarez, Manuel; Aldama, Patricia Chico; Álvarez, Juan Carlos; Fernández, Marta Luisa Hernández; Méndez, Juan Carlos

doi:10.1016/s2173-5735(08)70238-2

Cited by 9 publications

(17 citation statements)

References 9 publications

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“…32 Therefore, diagnostic and therapeutic management of ED patients given BPPV and APV diagnoses should differ substantially. However, like others, 40,41 we have noticed an overgeneralized approach to frontline management of patients with ''dizziness'' or ''vertigo.'' Recent reports suggest that ED and other primary care providers may not be entirely comfortable interpreting bedside findings in vestibular disorders.…”

supporting

confidence: 66%

“…It is conceivable that these discrepancies reflect inadequate or erroneous documentation, rather than wrong diagnoses or management. However, studies of diagnosis and management of confirmed causes for ED dizziness such as BPPV 41,66 or stroke 60,67 suggest real errors are frequent. Because there are no codes in the NHAMCS data set that distinguish the body part imaged, we cannot be sure that all CT imaging was actually neuroimaging.…”

Section: Limitationsmentioning

confidence: 99%

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Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Newman‐Toker

Camargo

Hsieh

et al. 2009

Academic Emergency Medicine

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Objectives: The most common vestibular disorders seen in the emergency department (ED) are benign paroxysmal positional vertigo (BPPV) and acute peripheral vestibulopathy (APV; i.e., vestibular neuritis or labyrinthitis). BPPV and APV are two very distinct disorders that have different clinical presentations that require different diagnostic and treatment strategies. BPPV can be diagnosed without imaging and is treated with canalith-repositioning maneuvers. APV sometimes requires neuroimaging by magnetic resonance imaging (MRI) to exclude posterior fossa stroke mimics and should be treated with vestibular sedatives and corticosteroids. We sought to determine if emergency physicians (EPs) apply best practices to diagnose and treat these common vestibular disorders.Methods: This was a cross-sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS). A weighted sample of U.S. ED visits (1993ED visits ( -2005 was used. Patients at least 16 years of age who were given a final ED diagnosis of BPPV (International Classification of Diseases, 9th Revision [ICD-9], 386.11) or APV (ICD-9 386.12 or 386.3x) comprised the study population. The frequency of imaging and drug therapy in those diagnosed as BPPV or APV versus controls was the main outcome measure.Results: A total of 9,472 dizzy patient visits were sampled over 13 years (weighted estimate 33.6 million U.S. ED visits over that period). A weighted estimate of 2.5 million patients (7.4%) were given a vestibular diagnosis, mostly BPPV (weighted 0.2 million) or APV (weighted 1.9 million). Patients given BPPV (19%) and APV (19%) diagnoses were more likely to undergo imaging (all by computed tomography [CT]) than controls (7%; p < 0.001). Patients given BPPV (58%) and APV (70%) diagnoses were more likely to receive meclizine than controls (0.1%; p < 0.001). Corticosteroid administration was rarely documented (2% BPPV, 1% APV).Conclusions: Patients given a vestibular diagnosis in the ED may not be managed optimally. Patients given BPPV and APV diagnoses undergo imaging (predominantly CT) with equal frequency, suggesting overuse of CT (BPPV) and probably underuse of MRI (APV). Most patients diagnosed with BPPV are given meclizine, which is not indicated. Specific therapy for APV (corticosteroids) is probably underutilized. Educational initiatives and clinical guidelines merit consideration.ACADEMIC EMERGENCY MEDICINE 2009; 16:970-977 ª

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supporting

confidence: 66%

Section: Limitationsmentioning

confidence: 99%

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Newman‐Toker

Camargo

Hsieh

et al. 2009

Academic Emergency Medicine

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“…Despite BPPV being the most common vestibular disorder, it is not well known in clinical practice outside specialty neuro-otologic clinics, and this lack of information among clinicians leads to a delay in diagnosis and treatment of BPPV. 2 The natural history of BPPV is poorly understood and the disease is recurrent in around 40 percent of patients at two years, with an increase of recurrences associated with longer follow-up periods. 3 However, the panel has made recommendations against radiographic or vestibular testing, unless the diagnosis was uncertain or there were additional signs or symptoms unrelated to BPPV.…”

mentioning

confidence: 99%

“…The most relevant aspect in the CPG on BPPV is its educational purpose for the general clinician. Despite BPPV being the most common vestibular disorder, it is not well known in clinical practice outside specialty neuro‐otologic clinics, and this lack of information among clinicians leads to a delay in diagnosis and treatment of BPPV 2 . The natural history of BPPV is poorly understood and the disease is recurrent in around 40 percent of patients at two years, with an increase of recurrences associated with longer follow‐up periods 3 …”

mentioning

confidence: 99%

Article Commentary: Role of vestibular testing in diagnosis of benign paroxysmal positional vertigo

López-Escámez

2009

Otolaryngol.--head neck surg.

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Diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) is a mixture of empiricism of particle repositioning with the rationally-based knowledge obtained from clinical observations, histopathology, and neurophysiological experiments. The recently published clinical practice guideline on BPPV makes recommendations on the management of BPPV. One of the statements discourages the use of radiographic or vestibular testing, unless the diagnosis was uncertain or there were additional signs or symptoms unrelated to BPPV. The role of video-oculography in diagnosis and treatment of BPPV is argued, since vestibular testing has provided key relevant information to understand positional nystagmus in patients with BPPV.

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“…Even though benign in nature, patients with BPPV are markedly limited in their daily activities [10,11]. The medical costs for diagnosis of BPPV have been estimated at 2,000 US$ in the USA [12], 364 Euros (~ 450 US$) in Spain [13], RMB 4165.2 Yuan (~ 600 US$) in China [14], and 180 US$ in South Korea [9]. Therefore, the healthcare burden due to BPPV totals around 2 billion US$ in the USA per year [15] and is likely to increase as the population ages.…”

Section: Introductionmentioning

confidence: 99%

Update on benign paroxysmal positional vertigo

2020

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Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo worldwide. This review considers recent advances in the diagnosis and management of BPPV including the use of web-based technology and artificial intelligence as well as the evidence supporting the use of vitamin D supplements for patients with BPPV and subnormal serum vitamin D. Keywords Dizziness • Vertigo • Benign paroxysmal positional vertigo Hyo-Jung Kim and JaeHan Park equally contributed to this study.

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Evaluation of Benign Paroxysmal Positional Vertigo in Primary Health-Care and First Level Specialist Care

Cited by 9 publications

References 9 publications

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Article Commentary: Role of vestibular testing in diagnosis of benign paroxysmal positional vertigo

Update on benign paroxysmal positional vertigo

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