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Screening for vestibular disorders: a study of clinicians' compliance with recommended practices

机译：筛查前庭疾病：研究临床医生对推荐操作的依从性

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Background Dizziness and vertigo are very common patient complaints encountered by clinicians in both primary as well as specialty care in otolaryngology and neurology. Vestibular impairment is an underlying cause in as many as 45% of people complaining of dizziness. Most causes of vestibular impairment can be effectively treated; however, the diagnosis is frequently missed. The aim of this study was to examine clinical assessments used by providers in evaluating dizzy patients in outpatient clinics and the emergency department. Material and Method Computerized medical records of all patients receiving an ICD-9 diagnosis code for dizziness, including benign paroxysmal positional vertigo, Meniere's disease, and vestibular hypofunction over a six-month period at the Atlanta VA Medical Center were reviewed. Results 476 patients were identified and of these, 157 patients were included. Over two-thirds of providers (69%) used the patient's description of the dizziness for identifying the cause; however, significant variability was evident across disciplines, ranging from 84% of audiologists asking for a description of the dizziness to only 33% of geriatricians asking. 89% of providers did not evaluate a patient for BPPV by examining for positional nystagmus. Primary care clinicians referred 22% of dizzy patients to a specialist (neurotologist), geriatricians referred 17%, and emergency physicians referred only 16%. Conclusions Dizzy patients were not routinely screened for vestibular impairment based on available recommended practices, likely contributing to underdiagnosis and treatment. Results indicate a need for effective dissemination of guidelines to improve health care quality, increase awareness of medical risks, and enhance patient access to appropriate treatment.
机译：背景技术头晕和眩晕是耳鼻喉科和神经病学在初级和专科护理中临床医生经常遇到的患者主诉。前庭损害是多达45％的人抱怨头晕的根本原因。前庭损伤的大多数原因可以得到有效治疗;但是，经常会漏诊。这项研究的目的是检查提供者用于评估门诊和急诊科中头晕患者的临床评估。材料和方法在亚特兰大VA医疗中心对六个月内接受ICD-9头晕诊断代码的所有患者的计算机病历进行了计算机检查，包括良性阵发性位置性眩晕，梅尼埃病和前庭功能减退。结果鉴定出476例患者，其中包括157例患者。超过三分之二的提供者（69％）使用患者对头晕的描述来确定原因;但是，各学科之间存在明显的差异，从84％的听力学家要求描述头昏眼花到33％的老年医生要求。 89％的提供者未通过检查位置眼震来评估患者的BPPV。初级保健临床医生将头昏眼花的患者中的22％转诊给专科医生（神经科医生），老年医生将其转介给17％，急诊医生的转介率仅为16％。结论头晕患者没有根据可用的推荐操作常规筛查前庭损伤，可能导致诊断不足和治疗不足。结果表明需要有效传播指南，以改善医疗质量，提高对医疗风险的认识并增加患者获得适当治疗的机会。

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