| 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
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1Department of Emergency Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
2Department of Emergency Medicine, Jeroen Bosch Hospital, ’s-Hertogenbosch, Netherlands |
| Correspondence
Renske Eveline Henriëtte Maria Bijl Email: renske@moiety.me |
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Received: March 29, 2024. Revised: June 25, 2024. Accepted: June 28, 2024. Published online: July 19, 2024. |
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| ABSTRACT |
Objective
Acute vestibular syndrome (AVS) is a common symptom experienced by emergency department (ED) patients. Differentiating a 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
This was a multicenter retrospective cohort study of ED patients presenting with AVS in one of two hospitals during a 3-year period. The primary endpoints were incidence, diagnostics, and diagnosis at ED presentation versus follow-up. The secondary endpoint was type of therapy.
Results
Among the 500 AVS cases included, the annual incidence was 0.1%. Eighty-five ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) did not experience stroke, and 130 (26.0%) exhibited 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 (head impulse test, observation of nystagmus, test of skew; HINTS) was completed for 106 patients (21.2%), computed tomography (CT) scans were collected in 342 patients (68.4%), and magnetic resonance imaging scans were collected for 153 patients (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, the initial diagnosis was corrected to no stroke. Among eight patients who received thrombolysis, the initial diagnosis was corrected for three. Of those patients in whom 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 later corrected. This study substantiates that clinical practice lacks a uniform diagnostic pathway, with an overuse of CT imaging and underuse of HINTS. Further research on an optimal diagnostic approach is warranted to improve treatment of AVS. |
| Keywords:
Vertigo; Emergency departments; Patient outcome assessment; Retrospective studies; Netherlands |
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