PDF(Pubmed)
Abstract：
Acute vestibular syndrome (AVS) is characterised by a sudden vertigo, gait instability, nausea and nystagmus. Accurate and rapid triage of patients with AVS to differentiate central (potentially sinister) from peripheral (usually benign) root causes is a challenge faced across emergency medicine settings. While there exist bedside exams which can reliably differentiate serious cases, they are underused due to clinicians\' general unfamiliarity and low confidence interpreting results. Nystagmus is a fundamental part of AVS and can facilitate triaging, but identification of relevant characteristics requires expertise. This work presents two quantitative digital biomarkers from nystagmus analysis, which capture diagnostically-relevant information. The directionality biomarker evaluates changes in direction to differentiate spontaneous and gaze-evoked (direction-changing) nystagmus, while the intensity differential biomarker describes changes in intensity across eccentric gaze tests. In order to evaluate biomarkers, 24 sets of three gaze tests (left, right, and primary) are analysed. Both novel biomarkers were found to perform well, particularly directionality which was a perfect classifier. Generally, the biomarkers matched or eclipsed the performance of quantitative nystagmus features found in the literature. They also surpassed the performance of a support vector machine classifier trained on the same dataset, which achieved an accuracy of 75%. In conclusion, these biomarkers simplify the diagnostic process for non-specialist clinicians, bridging the gap between emergency care and specialist evaluation, ultimately benefiting patients with AVS.
摘要：
急性前庭综合征（AVS）的特征是突然的眩晕，步态不稳定,恶心和眼球震颤.对AVS患者进行准确和快速的分诊，以区分中枢（潜在的险恶）和外周（通常是良性的）根本原因是急诊医学设置面临的挑战。虽然有床边检查可以可靠地区分严重病例，由于临床医生普遍不熟悉和低置信度的解释结果，它们未得到充分利用。眼球震颤是AVS的基本组成部分，可以促进分类，但是识别相关特征需要专业知识。这项工作提出了两种来自眼球震颤分析的定量数字生物标志物，捕获诊断相关信息。方向性生物标志物评估方向的变化，以区分自发和凝视诱发（方向改变）的眼球震颤，而强度差异生物标志物描述了偏心凝视测试中强度的变化。为了评估生物标志物，24组三个凝视测试（左，对,和主要)进行了分析。两种新的生物标志物都表现良好，特别是方向性，这是一个完美的分类器。一般来说,这些生物标志物与文献中发现的定量眼震特征的表现相匹配或黯然失色.他们还超越了在同一数据集上训练的支持向量机分类器的性能，达到了75%的准确率。总之,这些生物标志物简化了非专业临床医生的诊断过程，弥合急诊护理和专家评估之间的差距，最终使AVS患者受益。
