Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Pusan, Korea.
Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
J Neurol. 2020 Jun;267(6):1709-1714. doi: 10.1007/s00415-020-09763-x. Epub 2020 Feb 25.
This study aimed to define the factors affecting accuracy of bedside determination of the involved side in HC-BPPV.
We developed 44 video clips including the nystagmus induced during supine head-roll test from patients with apogeotropic (n = 23) or geotropic (n = 21) HC-BPPV. The intensity of nystagmus was also quantified using video-oculography. Each video clip was presented twice to 25 participants, 14 medical students, and 11 medical personnel trained in neurology or neurotology, and the participants reported the lesion side using an evaluation sheet after each presentation. From the quantified video-oculographic data, absolute difference and asymmetry (absolute difference divided by the sum) of nystagmus intensity were calculated.
The accuracy of bedside lateralization of HC-BPPV was 83.5% after the first presentation, and 86.0% after the second presentation, and was not different between the medical students and trained personnel after the second presentation. The accuracy was more closely correlated with the asymmetry than the absolute difference (Spearman's ρ = 0.627, p < 0.001). With a cut-off for the asymmetry at 30.8%, the accuracy was estimated at 93.8% with a sensitivity of 92.9%, and the area under the ROC curve of 0.779.
The accuracy of bedside lateralization of the affected side is acceptable in HC-BPPV when the nystagmus asymmetry is more than 30%.
本研究旨在确定影响床边 HC-BPPV 受累侧判断准确性的因素。
我们制作了 44 个视频片段，包括仰卧位头滚试验诱发的向地性（n=23）或背地性（n=21）HC-BPPV 患者的眼震。使用视频眼震图还定量了眼震强度。每个视频片段向 25 名参与者（14 名医学生和 11 名接受神经病学或耳神经外科学培训的医务人员）呈现两次，参与者在每次呈现后使用评估表报告病变侧。从量化的视频眼震图数据中，计算了眼震强度的绝对差值和不对称性（绝对差值除以总和）。
第一次呈现后，HC-BPPV 的床边定位准确性为 83.5%，第二次呈现后为 86.0%，第二次呈现后医学生和训练有素的医务人员之间无差异。准确性与不对称性的相关性比绝对差值更密切（Spearman's ρ=0.627，p<0.001）。当不对称性的截断值为 30.8%时，敏感性为 92.9%，ROC 曲线下面积为 0.779，估计准确性为 93.8%。
当眼震不对称性大于 30%时，床边定位 HC-BPPV 受累侧的准确性可以接受。
