Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan.
Department of Emergency Medicine, International University of Health and Welfare, Mita hospital, Mita, Minato-ku Tokyo, Japan.
PLoS One. 2019 Mar 7;14(3):e0213196. doi: 10.1371/journal.pone.0213196. eCollection 2019.
Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07-0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06-0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01-5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07-0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01-0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85-61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.
急性眩晕是急诊科常见的问题。然而，不同的医疗服务提供者对急性眩晕的临床治疗策略存在差异。本研究旨在探讨耳鼻喉科医生和非耳鼻喉科医生在急诊科对急性眩晕的诊断[Dix-Hallpike 试验、头部脉冲试验、眼震和偏斜试验（HINTS）程序以及影像学检查]和治疗（药物治疗和 Epley 手法）的差异。我们使用基于多中心病例的调查进行了这项研究。共使用了 4 个急性眩晕病例（后半规管良性阵发性位置性眩晕、前庭神经炎、梅尼埃病和非特异性眩晕）。来自所有研究地点的 151 名医生参与了这项研究。其中 84 名是非耳鼻喉科医生（48 名急诊医生和 36 名内科医生），67 名是耳鼻喉科医生。多变量分析表明，耳鼻喉科医生较少进行 CT 扫描（比值比（OR），0.20；95%置信区间（CI），0.07-0.53）和较少进行 HINTS 检查（OR，0.17；95%CI，0.06-0.46），但较非耳鼻喉科医生更常使用 Dix-Hallpike 方法进行诊断（OR，2.36；95%CI，1.01-5.52）。在治疗方面，耳鼻喉科医生较少使用 Epley 手法（OR，0.19；95%CI，0.07-0.53）和甲氧氯普胺（OR，0.09；95%CI，0.01-0.97），而更可能使用碳酸氢钠（OR，20.50；95%CI，6.85-61.40）。基于病例的研究发现，非耳鼻喉科医生和耳鼻喉科医生在急性眩晕治疗方面存在显著差异。为了改善急性眩晕的治疗，需要建立以急性眩晕为重点的教育系统。
