https://doi.org/10.4081/ecj.2020.8848

STANDING update: A retrospective analysis in the Emergency Department one year after its validation

Vol. 16 No. 2 (2020)
Submitted: 26 January 2020
Accepted: 18 May 2020
Published: 31 August 2020
dizziness, vertigo, Audiology Unit, Syncope Unit
Abstract Views: 779
PDF: 341
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Alice Ceccofiglio
Syncope Unit, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
Rudi Pecci
peccirudi@gmail.com
Unit of Audiology, Head and Neck Oncological and Robotic Surgery, Oncology and Robotic Surgery Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
Giulia Peruzzi
Syncope Unit, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
Giulia Rivasi
Syncope Unit, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
Martina Rafanelli
Syncope Unit, Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Italy.
Simone Vanni
Andrea Ungar
Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.

A structured four-step bedside algorithm, named SponTAneous Nystagmus, Direction, head Impulse test, standiNG (STANDING), has been proposed to differentiate central from peripheral acute vestibulopathy in the Emergency Department (ED). We aimed to evaluate the effective application of STANDING in the management of vertigo in the ED and to define its role in deciding the patient’s pathway after discharge. We retrospectively analysed data from 131 consecutive patients (65% female, mean age 56) undergoing ED visits for a vertigo complaint between April and May 2016. Our study showed that the STANDING algorithm is underused, being performed only in the 18% of patients. The positivity of the STANDING did not influence the choice of the following pathway (e.g. outpatient fast track or discharge). Moreover, a small percentage of patients had a non-audiological diagnosis (mainly presyncope), for which no defined pathways were yet foreseen. Our study emphasized the need for continuous updating with appropriate training courses and the importance of a multidisciplinary assessment of vertigo in the ED.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch Intern Med 1993;153:2474-80. DOI: https://doi.org/10.1001/archinte.1993.00410210102011
Yardley L, Owen N, Nazareth I, Luxon L. Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 1998;48:1131-5.
Hannaford PC, Simpson JA, Bisset AF, et al. The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract 2005;22:227-33. DOI: https://doi.org/10.1093/fampra/cmi004
Neuhauser HK, von Brevern M, Radtke A, et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005;65:898-904. DOI: https://doi.org/10.1212/01.wnl.0000175987.59991.3d
Neuhauser HK, Radtke A, von Brevern M, et al. Burden of dizziness and vertigo in the community. Arch Intern Med 2008;168:2118-24. DOI: https://doi.org/10.1001/archinte.168.19.2118
Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. Acad Emerg Med 2008;15:744-50. DOI: https://doi.org/10.1111/j.1553-2712.2008.00189.x
Newman-Toker DE, Hsieh YH, Camargo CA Jr, et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc 2008;83:765-75. DOI: https://doi.org/10.4065/83.7.765
Eagles D, Stiell IG, Clement CM, et al. International survey of emergency physicians’ priorities for clinical decision rules. Acad Emerg Med 2008;15:177-82. DOI: https://doi.org/10.1111/j.1553-2712.2008.00035.x
Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006;37:2484-7. DOI: https://doi.org/10.1161/01.STR.0000240329.48263.0d
Kerber KA. Vertigo presentations in the emergency department. Semin Neurol 2009;29:482-90. DOI: https://doi.org/10.1055/s-0029-1241036
Vanni S, Pecci R, Casati C, et al. STANDING, a four-step bedside algorithm for differential diagnosis of acute vertigo in the emergency department. Acta Otorhinolaryngol Ital 2014;34:419-26.
Vanni S, Nazerian P, Casati C, et al. Can emergency physicians accurately and reliably assess acute vertigo in the emergency department? Emerg Med Australas 2015;27:126-31. DOI: https://doi.org/10.1111/1742-6723.12372
Vanni S, Pecci R, Edlow JA, et al. Differential diagnosis of vertigo in the emergency department: a prospective validation study of the STANDING algorithm. Front Neurol 2017;8:1-9. DOI: https://doi.org/10.3389/fneur.2017.00590
Madlon-Kay DJ. Evaluation and outcome of the dizzy patient. J Fam Pract 1985;21:109-13.
Tarnutzer AA, Berkowitz AL, Robinson KA, et al. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011;183:571-92. DOI: https://doi.org/10.1503/cmaj.100174
Newman-Toker D, Kattah J, Talkad A, et al. H.I.N.T.S. to diagnose stroke in the acute vestibular syndrome-three-step bedside oculomotor exam more sensitive than early MRI DWI. Stroke 2009;40:3504-10. DOI: https://doi.org/10.1161/STROKEAHA.109.551234
Edlow JA, Newman-Toker D. Using the physical examination to diagnose patients with acute dizziness and vertigo. J Emerg Med 2016;50:617-28. DOI: https://doi.org/10.1016/j.jemermed.2015.10.040
McDowell T, Moore F. The under-utilization of the head impulse test in the emergency department. Can J Neurol Sci 2016;43:398-401. DOI: https://doi.org/10.1017/cjn.2015.330
Quimby AE, Kwok ESH, Lelli D, et al. Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department. J Otolaryngol Head Neck Surg 2018;47:1-8. DOI: https://doi.org/10.1186/s40463-018-0305-8
Ceccofiglio A, Peruzzi G, Pecci R, et al. Retrospective analysis of patients with dizziness evaluated in syncope unit: a real-life experience. European Geriatric Medicine 2018;9:1-5. DOI: https://doi.org/10.1007/s41999-018-0058-y

How to Cite

Ceccofiglio, A., Pecci, R., Peruzzi, G., Rivasi, G., Rafanelli, M., Vanni, S., & Ungar, A. (2020). STANDING update: A retrospective analysis in the Emergency Department one year after its validation. Emergency Care Journal, 16(2). https://doi.org/10.4081/ecj.2020.8848

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.