Open AccessUse of BPPV Processes in Emergency Department Dizziness Presentations
Author(s) -
Kerber Kevin A.,
Burke James F.,
Skolarus Lesli E.,
Meurer William J.,
Callaghan Brian C.,
Brown Devin L.,
Lisabeth Lynda D.,
McLaughlin Thomas J.,
Fendrick A. Mark,
Morgenstern Lewis B.
Publication year - 2013
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599812471633
Subject(s) - benign paroxysmal positional vertigo , medicine , emergency department , confidence interval , odds ratio , intraclass correlation , logistic regression , population , triage , emergency medicine , vertigo , medical emergency , surgery , clinical psychology , environmental health , psychiatry , psychometrics
Objective 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. Study Design Prospective population‐based surveillance study. Setting Emergency departments in Nueces County, Texas, from January 15, 2008, to January 14, 2011. Subjects and Methods 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. Results 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. Conclusion 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.