Department of Neurology, The University of Iowa, Iowa City, Iowa.
Department of Emergency Medicine, The University of Iowa, Iowa City, Iowa.
J Emerg Med. 2021 Apr;60(4):485-494. doi: 10.1016/j.jemermed.2020.10.052. Epub 2020 Dec 8.
It is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes.
We evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness.
In this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient.
Seventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59-100%). The specificity of the BT was 38% (95% CI 24-52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15-21%).
The BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.
在因急性头晕而到急诊科就诊的患者中，很难检测出后循环卒中。目前的方法是采用头脉冲、眼震和偏斜试验相结合的方法，足以区分中枢性和外周性病因。但是，该方法较难实施且应用不足。此外，脑部磁共振成像（MRI）并非总是可用，且对检测后循环卒中的敏感性较低。
我们评估了桶试验（BT）作为一种筛选工具，用于检测因急性头晕而到急诊科就诊的患者是否发生卒中的可行性和实用性，该试验通过测量患者对视觉垂直的主观感知与真实垂直之间的差异来进行。
在这项工作中，我们前瞻性地招募了 81 名以头晕为主要症状到我们学术医疗中心急诊科就诊的患者。每位患者进行了 3 次 BT。
71 名符合研究标准的患者被纳入分析。10 名患者因有觅药史而被排除。BT 操作未出现报告困难。MRI 诊断 6 名患者（8%）为缺血性卒中，另有 1 名患者诊断为短暂性脑缺血发作，随后的 MRI 检查发现有卒中。所有 7 名因脑血管病因导致头晕的患者的 BT 结果均异常，其敏感性为 100%（95%置信区间 [CI]，59%-100%）。BT 的特异性为 38%（95% CI，24%-52%）。BT 对检测卒中的阳性预测值为 18%（95% CI，15%-21%）。
BT 是一种简便、廉价、安全且快速的检测方法，可用于筛选急诊科急性头晕患者是否发生卒中，且具有可行性和敏感性。
