Vanni S, Pecci R, Casati C, Moroni F, Risso M, Ottaviani M, Nazerian P, Grifoni S, Vannucchi P
Department of Emergency Medicine, Careggi Hospital, University of Firenze, Italy;
Department of Surgical Sciences and Translational Medicine, Unit of Audiology, Careggi Hospital, University of Firenze, Italy.
Acta Otorhinolaryngol Ital. 2014 Dec;34(6):419-26.
Vertigo is generally due to a benign disorder, but it is the most common symptom associated with misdiagnosis of stroke. In this pilot study, we preliminarily assessed the diagnostic performance of a structured bedside algorithm to differentiate central from non-central acute vertigo (AV). Adult patients presenting to a single Emergency Department with vertigo were evaluated with STANDING (SponTAneous Nystagmus, Direction, head Impulse test, standiNG) by one of five trained emergency physicians or evaluated ordinarily by the rest of the medical staff (control group). The gold standard was a complete audiologic evaluation by a clinicians who are experts in assessing dizzy patients and neuroimaging. Reliability, sensibility and specificity of STANDING were calculated. Moreover, to evaluate the potential clinical impact of STANDING, neuroimaging and hospitalisation rates were compared with control group. A total of 292 patients were included, and 48 (16.4%) had a diagnosis of central AV. Ninety-eight (33.4%) patients were evaluated with STANDING. The test had good interobserver agreement (k = 0.76), with very high sensitivity (100%, 95%CI 72.3-100%) and specificity (94.3%, 95%CI 90.7-94.3%). Furthermore, hospitalisation and neuroimaging test rates were lower in the STANDING than in the control group (27.6% vs. 50.5% and 31.6% vs. 71.1%, respectively). In conclusion, STANDING seems to be a promising simple structured bedside algorithm that in this preliminary study identified central AV with a very high sensitivity, and was associated with significant reduction of neuroimaging and hospitalisation rates.
眩晕一般由良性疾病引起，但它是与中风误诊相关的最常见症状。在这项初步研究中，我们初步评估了一种结构化床边算法区分中枢性与非中枢性急性眩晕（AV）的诊断性能。因眩晕就诊于单一急诊科的成年患者由五名经过培训的急诊医生之一采用STANDING（自发性眼球震颤、方向、头部脉冲试验、站立）进行评估，或由其他医务人员常规评估（对照组）。金标准是由评估眩晕患者的临床专家进行全面的听力学评估和神经影像学检查。计算STANDING的可靠性、敏感性和特异性。此外，为了评估STANDING的潜在临床影响，将神经影像学检查率和住院率与对照组进行比较。共纳入292例患者，其中48例（16.4%）诊断为中枢性AV。98例（33.4%）患者接受了STANDING评估。该测试具有良好的观察者间一致性（k = 0.76），敏感性非常高（100%，95%CI 72.3 - 100%），特异性为94.3%（95%CI 90.7 - 94.3%）。此外，STANDING组的住院率和神经影像学检查率低于对照组（分别为27.6%对50.5%和31.6%对71.1%）。总之，STANDING似乎是一种很有前景的简单结构化床边算法，在这项初步研究中，它以非常高的敏感性识别出中枢性AV，并与神经影像学检查率和住院率的显著降低相关。
