Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag

Goeldlin, Martina; Gaschen, Janika; Kammer, Christoph; Comolli, Lukas; Bernasconi, Corrado; Spiegel, Rainer; Bassetti, Claudio; Exadaktylos, Aristomenis K.; Lehmann, Beat; Mantokoudis, Georgios; Kalla, Roger; Fischer, Urs

doi:10.1007/s00415-019-09525-4

Cited by 23 publications

(31 citation statements)

References 21 publications

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“…Over the last years, emergency vertigo and dizziness became a research focus and a number of scores and algorithms have been described to overcome the challenges of making a fast and correct diagnosis [3,8,35]. This is crucial, as a substantial proportion of patients will suffer from serious causes of VD, in particular posterior circulation stroke.…”

Section: Discussionmentioning

confidence: 99%

Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

Jahn

Kreuzpointner²,

Pfefferkorn

et al. 2020

J Neurol

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Distinguishing between serious (e.g., stroke) and benign (e.g., benign paroxysmal positional vertigo, BPPV) disorders remains challenging in emergency consultations for vertigo and dizziness (VD). A number of clues from patient history and clinical examination, including several diagnostic index tests have been reported recently. The objective of the present study was to analyze frequency and distribution patterns of specific vestibular and non-vestibular diagnoses in an interdisciplinary university emergency room (ER), including data on daytime and season of presentation. A retrospective chart analysis of all patients seen in a one-year period was performed. In the ER 4.23% of all patients presented with VD (818 out of 19,345). The most frequent-specific diagnoses were BPPV (19.9%), stroke/transient ischemic attack (12.5%), acute unilateral vestibulopathy/ vestibular neuritis (UVH; 8.3%), and functional VD (8.3%). Irrespective of the diagnosis, the majority of patients presented to the ER between 8 a.m. and 4 p.m. There are, however, seasonal differences. BPPV was most prevalent in December/ January and rare in September. UVH was most often seen in October/November; absolute and relative numbers were lowest in August. Finally, functional/psychogenic VD was common in summer and autumn with highest numbers in September/ October and lowest numbers in March. In summary, daytime of presentation did not distinguish between diagnoses as most patients presented during normal working hours. Seasonal presentation revealed interesting fluctuations. The UVH peak in autumn supports the viral origin of the condition (vestibular neuritis). The BPPV peak in winter might be related to reduced physical activity and low vitamin D. However, it is likely that multiple factors contribute to the fluctuations that have to be disentangled in further studies.

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Section: Discussionmentioning

confidence: 99%

Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

Jahn

Kreuzpointner²,

Pfefferkorn

et al. 2020

J Neurol

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“…The interdisciplinary database on vertigo and dizziness is a retrospective, single-centre, REDCap database based on ED medical reports on patients with vestibular symptoms who had visited the ED in 2013 [13,14]. Briefly, we manually screened all ED reports from the year 2013 for descriptions of vestibular symptoms.…”

Section: Interdisciplinary Database On Vertigo and Dizzinessmentioning

confidence: 99%

Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin

et al. 2020

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Background: Vestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations. Methods: This retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was 'vestibular symptoms'. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis. Results: A total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians' work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging. Conclusion: One in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.

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“…Dizziness is a common symptom encountered daily (1)(2)(3). Most patients are without life-threatening condition except intolerable symptoms (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…Dizziness is a common symptom of emergency visit (1)(2)(3). Although the majority is peripheral type and not serious (4,5), but a small portion is central type and life-threatening (6, 7).…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

The Efficacy And Safety of Traditional Chinese Medicine (TCM) To The Patient With Dizziness In Emergency Department — A Randomized Controlled Trial

Chiu¹,

Lee²,

Chen³

et al. 2021

Preprint

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• Background: A new way of heat treatment with far-infrared and / or acupuncture on acupoints is studied to treat the stubborn dizziness of patients.• Methods: A single-blinded 4-arms parallel randomized controlled trial is designed: arm of acupuncture, arm of far-infrared, arm of acupuncture plus far-infrared, arm of placebo with no far-infrared. There are four acupoints on left limbs and four acupoints on right limbs correspondingly, named as Neiguan (PC6), Hegu (LI4), Zusanli (ST36), and Taichong (LR3). The intervention time is 20 minutes for each. After treatment, visual analogue scale of dizziness, dizziness handicap intervention questionnaire and heart rate variability are used to measure and evaluate the results.• Discussion: This is a prior study in use of far-infrared and / or acupuncture on acupoints for the treatment of stubborn dizziness. It promotes the basis to further acupoints treatment according to the concept of traditional Chinese medicine.• Trial registration: It was registered in ClinicalTrials.gov with number NCT04415307 on date June 1, 2020.

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Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag

Cited by 23 publications

References 21 publications

Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

Telling friend from foe in emergency vertigo and dizziness: does season and daytime of presentation help in the differential diagnosis?

Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin

The Efficacy And Safety of Traditional Chinese Medicine (TCM) To The Patient With Dizziness In Emergency Department — A Randomized Controlled Trial

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