A multicenter retrospective cohort study on incidence and diagnostics in emergency department patients with acute vestibular syndrome

Bijl, Renske Eveline Henriëtte Maria; Zaunbrecher, Domenique Wilhelmina Antonia Maria; de Muynck, Petra Mathilda; Eggink, Ryanne; Timmer, Ronique; Willems, Evian; Koning, Sam; Sanders, Marieke Saskia; Jie, Kim Ellis

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Original Article

doi: https://doi.org/10.15441/ceem.24.225 [Accepted]

A multicenter retrospective cohort study on incidence and diagnostics in emergency department patients with acute vestibular syndrome

Renske Eveline Henriëtte Maria Bijl¹, Domenique Wilhelmina Antonia Maria Zaunbrecher², Petra Mathilda de Muynck², Ryanne Eggink¹, Ronique Timmer¹, Evian Willems², Sam Koning², Marieke Saskia Sanders¹, Kim Ellis Jie²

¹St. Antonius hospital, Nieuwegein and Utrecht, the Netherlands
²Jeroen Bosch hospital, ’s Hertogenbosch, the Netherlands

Correspondence Renske Eveline Henriëtte Maria Bijl Email: renske@moiety.me

Received: March 29, 2024. Revised: June 25, 2024. Accepted: June 28, 2024. Published online: July 19, 2024.

ABSTRACT

Objective
Acute vestibular syndrome (AVS) is a common symptom presented by emergency department (ED) patients. Differentiating peripheral from central etiology poses a challenge and clinical practice lacks a uniform diagnostic approach. This study aims to provide insight on incidence and diagnostics in ED patients presenting with AVS in the Netherlands.
Methods
A multicenter retrospective cohort study on ED patients presenting with AVS in two hospitals during 3 years. Primary endpoints are incidence, diagnostics and diagnosis at ED versus follow-up. A secondary endpoint includes therapy.
Results
500 AVS cases were included. The annual incidence was 0.1%. 85 ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) with non-stroke and 130 (26.0%) with an unsure etiology. At follow-up, diagnosis was corrected in 145 patients (29.0%), with stroke missed in 29 (5.8%). A triad of clinical tests (HINTS) was reported in 106 (21.2%) patients, a CT in 342 (68.2%) and a MRI in 153 (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, initial diagnosis was corrected to non-stroke. For 8 patients who received thrombolysis, initial diagnosis was corrected in 3. Of those patients where stroke was initially not identified, 23 (79%) received suboptimal treatment in lieu of antiplatelet therapy.
Conclusion
The annual incidence of AVS in Dutch ED patients is 0.1%. ED diagnosis is often uncertain, with one-third of diagnoses corrected. This study substantiates clinical practice lacks a uniform diagnostic pathway with an overuse of CT and underuse of HINTS. Further research on optimal diagnostic approach is warranted to improve treatment of AVS.

Keywords: Vertigo, emergency department, patient outcome assessment, retrospective studies, Netherlands