Herr R D, Alvord L, Johnson L, Valenti D, Mabey B
Division of Emergency Medicine, University of Utah Medical School, Salt Lake City.
Ann Emerg Med. 1993 Jul;22(7):1182-9. doi: 10.1016/s0196-0644(05)80986-2.
To determine whether the results of electronystagmography (ENG) testing improve an emergency physician's diagnosis of dizziness.
Prospective, one-year.
University and three community hospital emergency departments.
Ninety-three consecutive patients presenting with dizziness.
ED impression was recorded after complete ED evaluation. An ENG was performed within one hour by an audiologist, who gave a reading of "central," "peripheral," or "normal." The result was given to the emergency physician, who was invited to revise his or her impression (the "ED impression after ENG result"). Final diagnosis was based on the ED impression and by contact with the patient's physician(s) as well as the patient by telephone after one and four weeks. Accuracy of ENG was assessed by comparing ENG reading with the final diagnosis using the chi(2) test. In addition, the contribution of ENG to ED diagnosis was assessed by comparing the accuracy of the ED impression after ENG reading with the ED impression alone using McNemar's test (hit versus no-hit).
Both ED impression and the ENG significantly correlated with the final diagnostic category (chi(2) = 104.9, P < .001; chi(2) = 70.79, P < .001, respectively). ENG correctly diagnosed nine of 11 patients with central dizziness. Of 23 patients with undetermined cause after ED evaluation, ENG correctly identified seven patients with peripheral dizziness and three with central dizziness. ED impression after ENG reading was more accurate than ED impression alone (chi(2) = 6.13, P < .05).
Emergency physicians correctly categorized most dizzy patients, but audiologist performance and interpretation of an ENG significantly improved this categorization. ENG may have the potential to identify clinically unsuspected central dizziness and to categorize dizziness of "unknown" cause. Further study is needed to determine whether ENG could be performed by modifying certain types of heart monitors available in the ED.
确定眼震电图（ENG）测试结果是否能改善急诊医生对头晕的诊断。
前瞻性，为期一年。
大学及三家社区医院急诊科。
连续93例因头晕就诊的患者。
在急诊部完成全面评估后记录急诊印象。由听力学家在一小时内进行ENG检查，并给出“中枢性”、“外周性”或“正常”的诊断结果。该结果告知急诊医生，医生可据此修改其印象（“ENG结果后的急诊印象”）。最终诊断基于急诊印象，并在一周和四周后通过与患者的医生及患者本人电话联系得出。使用卡方检验通过比较ENG诊断结果与最终诊断来评估ENG的准确性。此外，通过使用McNemar检验（判断是否正确诊断）比较ENG结果后的急诊印象与单独的急诊印象的准确性，来评估ENG对急诊诊断的贡献。
急诊印象和ENG均与最终诊断类别显著相关（卡方值分别为104.9，P < 0.001；卡方值为70.79，P < 0.001）。ENG正确诊断出11例中枢性头晕患者中的9例。在急诊评估后病因未明的23例患者中，ENG正确识别出7例外周性头晕患者和3例中枢性头晕患者。ENG结果后的急诊印象比单独的急诊印象更准确（卡方值 = 6.13，P < 0.05）。
急诊医生能正确分类大多数头晕患者，但听力学家对ENG的操作及解读显著改善了这种分类。ENG可能有潜力识别临床上未被怀疑的中枢性头晕，并对“病因不明”的头晕进行分类。需要进一步研究以确定是否可通过改装急诊部现有的某些类型的心脏监测仪来进行ENG检查。
