OBJECTIVE Many patients attending the emergency room (ER) with vertigo, leave without a diagnosis. We assessed whether the three tools could improve ER diagnosis of vertigo. METHODS A prospective observational study was undertaken on 539 patients presenting to ER with vertigo. We used three tools: a structured-history and examination, nystagmus video-oculography (VOG) in all patients, additional video head-impulse testing (vHIT) for acute-vestibular-syndrome (AVS). RESULTS In the intervention-group (n = 424), case-history classified AVS in 34.9%, episodic spontaneous-vertigo (ESV 32.1%), and episodic positional-vertigo (EPV 22.6%). In AVS, we employed "Quantitative-HINTS plus" (Head-Impulse, Nystagmus and Test-of-Skew quantified by vHIT and VOG, audiometry) to identify vestibular-neuritis (VN) and stroke (41.2 and 31.1%). vHIT gain ≤ 0.72, catch-up saccade amplitude > 1.4○, saccade-frequency > 154%, and unidirectional horizontal-nystagmus, separated stroke from VN with 93.1% sensitivity and 88.5% specificity. In ESV, 66.2 and 14% were diagnosed with vestibular migraine and Meniere's Disease by using history and audiometry. Horizontal-nystagmus velocity was lower in migraine 0.4 ± 1.6○/s than Meniere's 5.7 ± 5.5○/s (p < 0.01). In EPV, benign positional vertigo (BPV) was identified in 82.3% using VOG. Paroxysmal positional-nystagmus lasting < 60 s separated BPV from non-BPV with 90% sensitivity and 100% specificity. In the control group of ER patients undergoing management-as-usual (n = 115), diagnoses included BPV (38.3%) and non-specific vertigo (41.7%). Unblinded assessors reached a final diagnosis in 90.6 and 30.4% of the intervention and control groups. Blinded assessors provided with the data gathered from each group reached a diagnosis in 86.3 and 41.1%. CONCLUSION Three tools: a structured-assessment, vHIT and VOG doubled the rate of diagnosis in the ER.

中文翻译：

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在急诊室捕捉眩晕：使诊断率加倍的三种工具。

目的 许多因眩晕就诊于急诊室 (ER) 的患者在没有得到诊断的情况下就离开了。我们评估了这三种工具是否可以改善眩晕的 ER 诊断。方法 对 539 名因眩晕入急诊室的患者进行了一项前瞻性观察研究。我们使用了三种工具：结构化病史和检查、所有患者的眼球震颤视频眼动描记术 (VOG)、针对急性前庭综合征 (AVS) 的额外视频头脉冲测试 (vHIT)。结果 在干预组 (n = 424) 中，病历分类 AVS 占 34.9%、发作性自发性眩晕 (ESV 32.1%) 和发作性位置性眩晕 (EPV 22.6%)。在 AVS 中，我们采用“Quantitative-HINTS plus”（通过 vHIT 和 VOG、听力测量法量化的甩头、眼球震颤和偏斜测试）来识别前庭神经炎 (VN) 和中风（41.2% 和 31.1%）。vHIT 增益 ≤ 0。72，追赶扫视幅度 > 1.4○，扫视频率 > 154%，单向水平眼球震颤，以 93.1% 的敏感性和 88.5% 的特异性将中风与 VN 分开。在 ESV 中，66.2% 和 14% 的患者通过病史和听力测试被诊断出患有前庭偏头痛和美尼尔氏病。偏头痛患者的水平眼球震颤速度为 0.4 ± 1.6○/s，低于梅尼埃的 5.7 ± 5.5○/s (p < 0.01)。在 EPV 中，良性位置性眩晕 (BPV) 使用 VOG 在 82.3% 中被识别出来。持续时间 < 60 秒的阵发性位置性眼球震颤将 BPV 与非 BPV 分开，敏感性为 90%，特异性为 100%。在接受常规治疗的 ER 患者对照组 (n = 115) 中，诊断包括 BPV (38.3%) 和非特异性眩晕 (41.7%)。非盲评估人员在 90.6% 的干预组和 30.4% 的干预组和对照组中得出最终诊断。提供从每组收集的数据的盲法评估员在 86.3% 和 41.1% 中做出了诊断。结论 三种工具：结构化评估、vHIT 和 VOG 使急诊室的诊断率翻了一番。