Recommendations include training in bedside physical exams for patients with acute vestibular syndrome, diagnostic and therapeutic maneuvers for benign paroxysmal positional vertigo
By Elana Gotkine HealthDay Reporter
THURSDAY, June 8, 2023 (HealthDay News) — In a consensus statement published in the May issue of Academic Emergency Medicine, guidelines are presented for the emergency department management of patients with new dizziness or vertigo without an obvious medical or neurological cause.
Jonathan A. Edlow, M.D., from Harvard Medical School in Boston, and colleagues developed guidelines relating to adults with acute dizziness and vertigo in the emergency department. Fifteen evidence-based recommendations were developed based on the timing and triggers of the dizziness.
The authors noted that emergency clinicians should receive training in bedside physical examination techniques for patients with acute vestibular syndrome (AVS) and diagnostic and therapeutic maneuvers for benign paroxysmal positional vertigo (BPPV) as an overarching recommendation. For patients with AVS, to help distinguish central from peripheral causes, HINTS (head impulse-nystagmus-test of skew) should be used in patients with nystagmus; finger rub can further aid with excluding stroke in patients with nystagmus; and severity of gait unsteadiness should be used in patients without nystagmus. Brain computed tomography should not be used. Routine magnetic resonance imaging should not be used as a first-line test if a clinician trained in HINTS is available, but can be used as a confirmatory test for patients with central or equivocal HINTS examination.
“The good news is with a bit of training and the algorithmic approach discussed in GRACE-3 [Guidelines for Reasonable and Appropriate Care in the Emergency Department 3], we can learn to take much better care of these patients, faster, with more confidence and less imaging,” Edlow said in a statement.
Several authors disclosed ties to industry.
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