Abstract：
UNASSIGNED: Acute vestibular syndrome (AVS) is a common symptom presented by emergency department (ED) patients. Differentiating 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.
UNASSIGNED: A multicenter retrospective cohort study on ED patients presenting with AVS in two hospitals during 3 years. Primary endpoints are incidence, diagnostics and diagnosis at ED versus follow-up. A secondary endpoint includes therapy.
UNASSIGNED: 500 AVS cases were included. The annual incidence was 0.1%. 85 ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) with non-stroke and 130 (26.0%) with 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 (HINTS) was reported in 106 (21.2%) patients, a CT in 342 (68.2%) and a MRI in 153 (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, initial diagnosis was corrected to non-stroke. For 8 patients who received thrombolysis, initial diagnosis was corrected in 3. Of those patients where stroke was initially not identified, 23 (79%) received suboptimal treatment in lieu of antiplatelet therapy.
UNASSIGNED: The annual incidence of AVS in Dutch ED patients is 0.1%. ED diagnosis is often uncertain, with one-third of diagnoses corrected. This study substantiates clinical practice lacks a uniform diagnostic pathway with an overuse of CT and underuse of HINTS. Further research on optimal diagnostic approach is warranted to improve treatment of AVS.
UNASSIGNED: A multicenter retrospective cohort study on ED patients presenting with AVS in two hospitals during 3 years. Primary endpoints are incidence, diagnostics and diagnosis at ED versus follow-up. A secondary endpoint includes therapy.
UNASSIGNED: 500 AVS cases were included. The annual incidence was 0.1%. 85 ED patients (17.0%) were diagnosed with stroke, 285 (57.0%) with non-stroke and 130 (26.0%) with 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 (HINTS) was reported in 106 (21.2%) patients, a CT in 342 (68.2%) and a MRI in 153 (30.6%). Antiplatelet therapy was prescribed in 135 cases. In 69% of these, initial diagnosis was corrected to non-stroke. For 8 patients who received thrombolysis, initial diagnosis was corrected in 3. Of those patients where stroke was initially not identified, 23 (79%) received suboptimal treatment in lieu of antiplatelet therapy.
UNASSIGNED: The annual incidence of AVS in Dutch ED patients is 0.1%. ED diagnosis is often uncertain, with one-third of diagnoses corrected. This study substantiates clinical practice lacks a uniform diagnostic pathway with an overuse of CT and underuse of HINTS. Further research on optimal diagnostic approach is warranted to improve treatment of AVS.
摘要：
■急性前庭综合征（AVS）是急诊科（ED）患者的常见症状。区分外周和中枢病因提出了挑战，临床实践缺乏统一的诊断方法。这项研究旨在提供对荷兰出现AVS的ED患者的发病率和诊断的见解。
■对两家医院在3年内出现AVS的ED患者的多中心回顾性队列研究。主要终点是发病率，ED时的诊断和诊断与随访。次要终点包括治疗。
■500例AVS病例。年发病率为0.1%。85例ED患者（17.0%）被诊断为中风，285（57.0％）患有非中风，130（26.0％）患有不确定的病因。在后续行动中,145例患者（29.0%）的诊断得到纠正，中风漏诊29例(5.8%)。在106例（21.2％）患者中报告了三联临床测试（HINTS），342例CT（68.2%），153例MRI（30.6%）。135例抗血小板治疗。其中69%，初步诊断校正为非卒中.对于接受溶栓治疗的8例患者，最初的诊断在3中得到纠正.在那些最初没有发现中风的患者中，23人(79%)接受次优治疗代替抗血小板治疗。
■荷兰ED患者AVS的年发病率为0.1%。ED诊断往往是不确定的，三分之一的诊断得到纠正。这项研究证实了临床实践缺乏统一的诊断途径，过度使用CT和使用HINTS。有必要对最佳诊断方法进行进一步研究，以改善AVS的治疗。
■对两家医院在3年内出现AVS的ED患者的多中心回顾性队列研究。主要终点是发病率，ED时的诊断和诊断与随访。次要终点包括治疗。
■500例AVS病例。年发病率为0.1%。85例ED患者（17.0%）被诊断为中风，285（57.0％）患有非中风，130（26.0％）患有不确定的病因。在后续行动中,145例患者（29.0%）的诊断得到纠正，中风漏诊29例(5.8%)。在106例（21.2％）患者中报告了三联临床测试（HINTS），342例CT（68.2%），153例MRI（30.6%）。135例抗血小板治疗。其中69%，初步诊断校正为非卒中.对于接受溶栓治疗的8例患者，最初的诊断在3中得到纠正.在那些最初没有发现中风的患者中，23人(79%)接受次优治疗代替抗血小板治疗。
■荷兰ED患者AVS的年发病率为0.1%。ED诊断往往是不确定的，三分之一的诊断得到纠正。这项研究证实了临床实践缺乏统一的诊断途径，过度使用CT和使用HINTS。有必要对最佳诊断方法进行进一步研究，以改善AVS的治疗。
