%0 Journal Article
%T A multicenter retrospective cohort study on incidence and diagnostics in emergency department patients with acute vestibular syndrome.
%A Bijl REHM
%A Zaunbrecher DWAM
%A de Muynck PM
%A Eggink R
%A Timmer R
%A Willems E
%A Koning S
%A Sanders MS
%A Jie KE
%J Clin Exp Emerg Med
%V 0
%N 0
%D 2024 Jul 19
%M 39026451
暂无%R 10.15441/ceem.24.225
%X <B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.