Diagnostic Accuracy of the STANDING Algorithm for the Differential Diagnosis of Vertigo in the Emergency Department: a Multicenter Study.
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 456
- 试验地点
- 4
- 主要终点
- Accuracy of STANDING algorithm for the diagnosis of types of vertigo.
研究概览
简要总结
Differential diagnosis of vertigo is complex especially in emergency department, nevertheless it is crucial. The aim of this study is to assess the accuracy of STANDING algorithm for discriminate central from peripheral type of vertigo, identifying more easily the presence of ischemic stroke.
详细描述
Vertigo represents a common medical problem which afflicts about 20-30% of the population and it is a frequent cause of abstention from work and disability. In most cases it is provoked by a benign disease of inner ear, however it can be the main symptom of a more dangerous illness like ischemic or hemorragic stroke, cerebral neoplasm or demyelinating disease. Indeed, vertigo is the prevailing clinical problem in patients with misdiagnosed ischemic stroke, leading to an increase of mortality in the acute phase of disease. In the current state, two diagnostic algorithm have been proposed for the evaluation of acute vertigo, named with the acronyms HINTS and STANDING. The former is characterized by high sensibility and specificity when utilized by a specialist physician, but it is cumbersome to used in emergency department. Conversely, the latter has been validated exactly in this setting and comprises the evaluation of benign paroxysmal positional vertigo and of upright position. The aim of this study is to estimate the accuracy of STANDING algorithm in differentiating peripheral vertigo from central from, in particular ischemic stroke, and its potential usefulness in decreasing the use of neuroimaging and specialist consultant.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •patients over 18 years of age.
- •patients affected by vertigo, dizziness or balance disorder.
排除标准
- •age under
- •patients unable to cooperate (with severe dementia or incapable to provide consensus).
- •patients affected by disease of cervical spine or any trauma of this part of body that contraindicate the manipulation of neck.
- •impractical follow-up.
- •dying patient (less three estimated months to live).
- •patients with neurologic deficit identified during triage examination (Cincinnati Prehospital stroke scale, CPSS>0) of suffering from another disease that can be the cause of dizziness/balance disorder (e.g. anemia, arrhythmia, hypoglycemia, alcoholic intoxication).
- •patients without symptoms at the time of examination.
- •patients who deny the participation in the study.
结局指标
主要结局
Accuracy of STANDING algorithm for the diagnosis of types of vertigo.
时间窗: Thirty days
Accuracy (proportion of true positive and negative cases among the total number of cases examined) together with sensitivity, specificity, negative and positive predictive values, negative and positive likelihood ratios of STANDING algorithm performed by emergency physicians to distinguish central and peripheral vertigo.
次要结局
- Change in the use of specialist consultant(thirty days)
- Safety of hospital discharge(Thirty days)
- Change in the use of neuroimaging(Thirty days)
- Accuracy for diagnosis of stroke(Thirty days)
研究者
Peiman Nazerian
Medical Doctor
Azienda Ospedaliero-Universitaria Careggi