Abstract:
Acute vertigo is defined as the perception of movement of oneself or the surroundings in the absence of actual motion and it is a frequent cause for emergency department admissions. The utilization of medical resources and the duration of hospital stay for this kind of symptom is high. Furthermore, the efficiency of brain imaging in the acute phase is low, considering the limited sensitivity of both CT and MRI for diagnosing diseases that are the causes of central type of vertigo. Relying on imaging tests can provide false reassurance in the event of negative results or prolong the in-hospital work-up improperly. On the other hand, clinical examinations, notably the assessment of nystagmus\' features, have proven to be highly accurate and efficient when performed by experts. Literature data point out that emergency physicians often do not employ these skills or use them incorrectly. Several clinical algorithms have been introduced in recent years with the aim of enhancing the diagnostic accuracy of emergency physicians when evaluating this specific pathology. Both the \'HINTS and \'STANDING\' algorithms have undergone external validation in emergency physician hands, showing good diagnostic accuracy. The objective of this consensus document is to provide scientific evidence supporting the clinical decisions made by physicians assessing adult patients with acute vertigo in the emergency department, particularly in cases without clear associated neurological signs. The document aims to offer a straightforward and multidisciplinary approach. At the same time, it tries to delineate benchmarks for the formulation of local diagnostic and therapeutic pathways, as well as provide a base for the development of training and research initiatives.
摘要:
急性眩晕被定义为在没有实际运动的情况下对自己或周围环境的运动的感知,这是急诊科入院的常见原因。此类症状的医疗资源利用率和住院时间较高。此外,急性期脑成像效率较低,考虑到CT和MRI对诊断作为中枢型眩晕病因的疾病的敏感性有限。在阴性结果的情况下,依靠影像学检查可能会提供错误的保证,或者不当延长院内检查。另一方面,临床检查,特别是对眼球震颤特征的评估,已被证明是高度准确和高效的由专家执行。文献数据指出,急诊医生通常没有使用这些技能或错误地使用它们。近年来,已经引入了几种临床算法,目的是提高急诊医师在评估这种特定病理时的诊断准确性。无论是“HINTS”和“STANDING”算法都经过了急诊医师手中的外部验证,显示出良好的诊断准确性。这份共识文件的目的是提供科学证据,支持医生在急诊科评估成年急性眩晕患者的临床决策。特别是在没有明确相关神经系统体征的情况下。该文件旨在提供一种直接和多学科的方法。同时,它试图划定制定本地诊断和治疗途径的基准,并为培训和研究计划的发展提供基础。