Original Articles Open access

STANDING update: A retrospective analysis in the Emergency Department one year after its validation

Authors

Published
31 August 2020
Section
Original Articles
DOI
10.4081/ecj.2020.8848

Abstract

A structured four-step bedside algorithm, named SponTAneous Nystagmus, Direction, head Impulse test, standiNG (STANDING), has been proposed to differentiate central from peripheral acute vestibulopathy in the Emergency Department (ED). We aimed to evaluate the effective application of STANDING in the management of vertigo in the ED and to define its role in deciding the patient’s pathway after discharge. We retrospectively analysed data from 131 consecutive patients (65% female, mean age 56) undergoing ED visits for a vertigo complaint between April and May 2016. Our study showed that the STANDING algorithm is underused, being performed only in the 18% of patients. The positivity of the STANDING did not influence the choice of the following pathway (e.g. outpatient fast track or discharge). Moreover, a small percentage of patients had a non-audiological diagnosis (mainly presyncope), for which no defined pathways were yet foreseen. Our study emphasized the need for continuous updating with appropriate training courses and the importance of a multidisciplinary assessment of vertigo in the ED.

Keywords

References

  1. Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 1993;153:2474-80. DOI: https://doi.org/10.1001/archinte.1993.00410210102011
  2. Yardley L, Owen N, Nazareth I, Luxon L. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 1998;48:1131-5.
  3. Hannaford PC, Simpson JA, Bisset AF, et al. The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract 2005;22:227-33. DOI: https://doi.org/10.1093/fampra/cmi004
  4. Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005;65:898-904. DOI: https://doi.org/10.1212/01.wnl.0000175987.59991.3d
  5. Neuhauser HK, Radtke A, von Brevern M, et al. Burden of dizziness and vertigo in the community. Arch Intern Med 2008;168:2118-24. DOI: https://doi.org/10.1001/archinte.168.19.2118
  6. Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. Acad Emerg Med 2008;15:744-50. DOI: https://doi.org/10.1111/j.1553-2712.2008.00189.x
  7. Newman-Toker DE, Hsieh YH, Camargo CA Jr, et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008;83:765-75. DOI: https://doi.org/10.4065/83.7.765
  8. Eagles D, Stiell IG, Clement CM, et al. International survey of emergency physicians’ priorities for clinical decision rules. Acad Emerg Med 2008;15:177-82. DOI: https://doi.org/10.1111/j.1553-2712.2008.00035.x
  9. Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006;37:2484-7. DOI: https://doi.org/10.1161/01.STR.0000240329.48263.0d
  10. Kerber KA. Vertigo presentations in the emergency department. Semin Neurol 2009;29:482-90. DOI: https://doi.org/10.1055/s-0029-1241036
  11. Vanni S, Pecci R, Casati C, et al. STANDING, a four-step bedside algorithm for differential diagnosis of acute vertigo in the emergency department. Acta Otorhinolaryngol Ital 2014;34:419-26.
  12. Vanni S, Nazerian P, Casati C, et al. Can emergency physicians accurately and reliably assess acute vertigo in the emergency department? Emerg Med Australas 2015;27:126-31. DOI: https://doi.org/10.1111/1742-6723.12372
  13. Vanni S, Pecci R, Edlow JA, et al. Differential diagnosis of vertigo in the emergency department: a prospective validation study of the STANDING algorithm. Front Neurol 2017;8:1-9. DOI: https://doi.org/10.3389/fneur.2017.00590
  14. Madlon-Kay DJ. Evaluation and outcome of the dizzy patient. J Fam Pract 1985;21:109-13.
  15. Tarnutzer AA, Berkowitz AL, Robinson KA, et al. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011;183:571-92. DOI: https://doi.org/10.1503/cmaj.100174
  16. Newman-Toker D, Kattah J, Talkad A, et al. H.I.N.T.S. to diagnose stroke in the acute vestibular syndrome-three-step bedside oculomotor exam more sensitive than early MRI DWI. Stroke 2009;40:3504-10. DOI: https://doi.org/10.1161/STROKEAHA.109.551234
  17. Edlow JA, Newman-Toker D. Using the physical examination to diagnose patients with acute dizziness and vertigo. J Emerg Med 2016;50:617-28. DOI: https://doi.org/10.1016/j.jemermed.2015.10.040
  18. McDowell T, Moore F. The under-utilization of the head impulse test in the emergency department. Can J Neurol Sci 2016;43:398-401. DOI: https://doi.org/10.1017/cjn.2015.330
  19. Quimby AE, Kwok ESH, Lelli D, et al. Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department. J Otolaryngol Head Neck Surg 2018;47:1-8. DOI: https://doi.org/10.1186/s40463-018-0305-8
  20. Ceccofiglio A, Peruzzi G, Pecci R, et al. Retrospective analysis of patients with dizziness evaluated in syncope unit: a real-life experience. European Geriatric Medicine 2018;9:1-5. DOI: https://doi.org/10.1007/s41999-018-0058-y

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