Use of BPPV Processes in Emergency Department Dizziness Presentations
Open Access
- 21 December 2012
- journal article
- research article
- Published by Wiley in Otolaryngology -- Head and Neck Surgery
- Vol. 148 (3), 425-430
- https://doi.org/10.1177/0194599812471633
Abstract
A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed and cured with the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM). We aimed to describe the use of these processes in emergency departments (EDs), assess for trends in use over time, and determine provider level variability in use. Prospective population-based surveillance study. Emergency departments in Nueces County, Texas, from January 15, 2008, to January 14, 2011. Adult patients discharged from EDs with dizziness, vertigo, or imbalance documented at triage. Clinical information was abstracted from source documents. A hierarchical logistic regression model adjusting for patient and provider characteristics was used to estimate trends in DHT use and provider-level variability. A total of 3522 visits for dizziness were identified. A DHT was documented in 137 visits (3.9%). A CRM was documented in 8 visits (0.2%). Among patients diagnosed with BPPV, a DHT was documented in only 21.8% (34 of 156) and a CRM in 3.9% (6 of 156). In the hierarchical model (c-statistic = 0.93), DHT was less likely to be used over time (odds ratio, 0.97; 95% confidence interval, 0.95-0.99), and the provider level explained 50% (intraclass correlation coefficient, 0.50) of the variance in the probability of DHT use. Benign paroxysmal positional vertigo is seldom examined for and, when diagnosed, infrequently treated in this ED population. Use of the DHT is decreasing over time and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize management in ED dizziness presentations.Keywords
This publication has 18 references indexed in Scilit:
- Nystagmus Assessments Documented by Emergency Physicians in Acute Dizziness Presentations: A Target for Decision Support?Academic Emergency Medicine, 2011
- Value of computed tomography scans in ED dizziness visits: analysis from a nationally representative sampleThe American Journal of Emergency Medicine, 2010
- The challenges of managing vestibular disorders: a qualitative study of clinicians’ experiences associated with low referral rates for vestibular rehabilitationInternational Journal of Clinical Practice, 2009
- Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative SampleAcademic Emergency Medicine, 2009
- Epidemiology of benign paroxysmal positional vertigo: a population based studyJournal of Neurology, Neurosurgery & Psychiatry, 2006
- Adequacy of Medical Chart Review to Characterize Emergency Care for Asthma: Findings from the Illinois Emergency Department Asthma CollaborativeAcademic Emergency Medicine, 2006
- Adequacy of Medical Chart Review to Characterize Emergency Care for Asthma: Findings from the Illinois Emergency Department Asthma CollaborativeAcademic Emergency Medicine, 2006
- Acute migrainous vertigo: clinical and oculographic findingsBrain, 2004
- Barriers to Acute Stroke Therapy and Stroke Prevention in Mexican AmericansStroke, 2001
- How Valid Are Medical Records and Patient Questionnaires for Physician Profiling and Health Services Research?Medical Care, 1998