Vanni Simone, Nazerian Peiman, Casati Carlotta, Moroni Federico, Risso Michele, Ottaviani Maddalena, Pecci Rudi, Pepe Giuseppe, Vannucchi Paolo, Grifoni Stefano
Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
Emerg Med Australas. 2015 Apr;27(2):126-31. doi: 10.1111/1742-6723.12372. Epub 2015 Mar 10.
To validate a clinical diagnostic tool, used by emergency physicians (EPs), to diagnose the central cause of patients presenting with vertigo, and to determine interrater reliability of this tool.
A convenience sample of adult patients presenting to a single academic ED with isolated vertigo (i.e. vertigo without other neurological deficits) was prospectively evaluated with STANDING (SponTAneousNystagmus, Direction, head Impulse test, standiNG) by five trained EPs. The first step focused on the presence of spontaneous nystagmus, the second on the direction of nystagmus, the third on head impulse test and the fourth on gait. The local standard practice, senior audiologist evaluation corroborated by neuroimaging when deemed appropriate, was considered the reference standard. Sensitivity and specificity of STANDING were calculated. On the first 30 patients, inter-observer agreement among EPs was also assessed.
Five EPs with limited experience in nystagmus assessment volunteered to participate in the present study enrolling 98 patients. Their average evaluation time was 9.9 ± 2.8 min (range 6-17). Central acute vertigo was suspected in 16 (16.3%) patients. There were 13 true positives, three false positives, 81 true negatives and one false negative, with a high sensitivity (92.9%, 95% CI 70-100%) and specificity (96.4%, 95% CI 93-38%) for central acute vertigo according to senior audiologist evaluation. The Cohen's kappas of the first, second, third and fourth steps of the STANDING were 0.86, 0.93, 0.73 and 0.78, respectively. The whole test showed a good inter-observer agreement (k = 0.76, 95% CI 0.45-1).
In the hands of EPs, STANDING showed a good inter-observer agreement and accuracy validated against the local standard of care.
验证一种由急诊医师（EP）使用的临床诊断工具，以诊断眩晕患者的中枢病因，并确定该工具的评分者间信度。
对因孤立性眩晕（即无其他神经功能缺损的眩晕）就诊于单一学术急诊科的成年患者进行便利抽样，由五名经过培训的急诊医师采用STANDING（自发性眼球震颤、方向、摇头试验、站立）进行前瞻性评估。第一步关注自发性眼球震颤的存在，第二步关注眼球震颤的方向，第三步关注摇头试验，第四步关注步态。当地标准做法，在认为适当时由高级听力学家评估并经神经影像学证实，被视为参考标准。计算STANDING的敏感性和特异性。对前30例患者，还评估了急诊医师之间的观察者间一致性。
五名在眼球震颤评估方面经验有限的急诊医师自愿参与本研究，共纳入98例患者。他们的平均评估时间为9.9±2.8分钟（范围6 - 17分钟）。16例（16.3%）患者被怀疑为中枢性急性眩晕。有13例假阳性、3例假阳性、81例假阴性和1例假阴性，根据高级听力学家评估，中枢性急性眩晕的敏感性较高（92.9%，95%可信区间70 - 100%），特异性较高（96.4%，95%可信区间93 - 98%）。STANDING第一步、第二步、第三步和第四步的Cohen's kappa值分别为0.86、0.93、0.73和0.78。整个测试显示出良好的观察者间一致性（k = 0.76，95%可信区间0.45 - 1）。
在急诊医师手中，STANDING显示出良好的观察者间一致性，并且相对于当地护理标准验证了其准确性。
