PDF(Pubmed)
Abstract：
To determine adherence to the 2017 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for the management and treatment of benign paroxysmal positional vertigo (BPPV) in primary care (PC) and compare whether key recommendations differed by sex, race, or insurance status.
Retrospective chart review.
Twenty-six clinic locations within a single healthcare system.
Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed. Encounters where the diagnosis of BPPV was made were identified. From the clinical encounter note, demographics, symptomatology, management, and treatment were extracted. Nonparametric analyses were used to identify whether AAO-HNS guidelines differed regarding sex, race, or insurance status.
Of 458 patients, 249 (54.4%) did not receive a diagnostic exam, and only 4 (0.9%) patients received imaging. Regarding treatment, only 51 (11.1%) received the Epley maneuver, with 263 (57.4%) receiving vestibular suppressant medication and 12.4% receiving a referral to a specialist. In regard to sex, race, or insurance status, there was no significant difference in receiving a Dix-Hallpike diagnostic maneuver, Epley maneuver, vestibular suppressant medication, imaging, or referral to a specialist.
Our data suggest that there continue to be gaps in the adherence to AAO-HNS guidelines; however, these gaps did not differ by sex, race, or insurance status. Care should be taken to increase the use of diagnostic and treatment maneuvers but decrease the use of vestibular-suppressant medications for the treatment of BPPV in PC.
Retrospective chart review.
Twenty-six clinic locations within a single healthcare system.
Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed. Encounters where the diagnosis of BPPV was made were identified. From the clinical encounter note, demographics, symptomatology, management, and treatment were extracted. Nonparametric analyses were used to identify whether AAO-HNS guidelines differed regarding sex, race, or insurance status.
Of 458 patients, 249 (54.4%) did not receive a diagnostic exam, and only 4 (0.9%) patients received imaging. Regarding treatment, only 51 (11.1%) received the Epley maneuver, with 263 (57.4%) receiving vestibular suppressant medication and 12.4% receiving a referral to a specialist. In regard to sex, race, or insurance status, there was no significant difference in receiving a Dix-Hallpike diagnostic maneuver, Epley maneuver, vestibular suppressant medication, imaging, or referral to a specialist.
Our data suggest that there continue to be gaps in the adherence to AAO-HNS guidelines; however, these gaps did not differ by sex, race, or insurance status. Care should be taken to increase the use of diagnostic and treatment maneuvers but decrease the use of vestibular-suppressant medications for the treatment of BPPV in PC.
摘要：
目的：确定对2017年美国耳鼻咽喉头颈外科学会（AAO-HNS）初级保健（PC）中良性阵发性位置性眩晕（BPPV）的管理和治疗指南的依从性，并比较关键建议是否因性别而异，种族,或保险状况。
方法：回顾性图表回顾。
方法：在一个医疗系统中有26个诊所。
方法：回顾性分析了2018年至2022年诊断为BPPV的458例PC患者的图表。确定了诊断为BPPV的情况。从临床接触记录来看，人口统计，症状学，管理,和治疗被提取。非参数分析用于确定AAO-HNS指南是否在性别方面有所不同，种族,或保险状况。
结果：在458名患者中，249（54.4%）没有接受诊断检查，只有4例(0.9%)患者接受影像学检查.关于治疗,只有51人(11.1%)接受了埃普利演习，263例(57.4%)接受前庭抑制药物治疗，12.4%接受专科医生转诊。关于性,种族,或保险状况，接受Dix-Hallpike诊断操作没有显着差异，Epley机动,前庭抑制药物,成像,或转介专家。
结论：我们的数据表明，在遵循AAO-HNS指南方面仍然存在差距；然而，这些差距没有性别差异，种族,或保险状况。应注意增加诊断和治疗手段的使用，但减少使用前庭抑制药物治疗PC中的BPPV。
方法：回顾性图表回顾。
方法：在一个医疗系统中有26个诊所。
方法：回顾性分析了2018年至2022年诊断为BPPV的458例PC患者的图表。确定了诊断为BPPV的情况。从临床接触记录来看，人口统计，症状学，管理,和治疗被提取。非参数分析用于确定AAO-HNS指南是否在性别方面有所不同，种族,或保险状况。
结果：在458名患者中，249（54.4%）没有接受诊断检查，只有4例(0.9%)患者接受影像学检查.关于治疗,只有51人(11.1%)接受了埃普利演习，263例(57.4%)接受前庭抑制药物治疗，12.4%接受专科医生转诊。关于性,种族,或保险状况，接受Dix-Hallpike诊断操作没有显着差异，Epley机动,前庭抑制药物,成像,或转介专家。
结论：我们的数据表明，在遵循AAO-HNS指南方面仍然存在差距；然而，这些差距没有性别差异，种族,或保险状况。应注意增加诊断和治疗手段的使用，但减少使用前庭抑制药物治疗PC中的BPPV。
