Decision support may aid emergency physicians in interpreting benign from serious eye movement patterns in dizzy patients
Dizziness or vertigo accounts for an estimated 2.6 million visits to U.S. emergency departments (EDs) annually. Patients with these symptoms are a source of angst for ED doctors, who have ranked decision support for dizziness presentations as a top priority. Dizziness can be caused by a variety of factors, most of which are self-limited (e.g., inner ear infections) but some of which can be life-threatening (e.g., ischemic strokes). An involuntary eye movement called nystagmus is a common feature in dizzy patients. Specific patterns of nystagmus are a key element in distinguishing self-limited from life-threatening causes of dizziness, according to specialists in this area.
A new study found that emergency physicians documented a nystagmus assessment in 81.3 percent of 1,091 visits for dizziness and found nystagmus to be present in 185 instances. However, the details of the nystagmus that were documented by emergency physicians allowed a meaningful inference about the cause of dizziness in only 10 cases. Certain patterns of nystagmus indicate a brain lesion from causes such as stroke, multiple sclerosis, or tumor. Other patterns are highly characteristic of peripheral vestibular dysfunction typically due to inner ear infection (vestibular neuritis) or benign paroxysmal positional vertigo. The researchers found that key details about the nystagmus were usually lacking, and when details were provided, the information typically did not enable a meaningful inference or even conflicted with the diagnosis rendered.
The researchers conclude that nystagmus assessments should be a target in the efforts to support decisionmaking in cases of acute dizziness. This could include online training modules, screen-based simulations, standardized patients, or charting templates. This study was supported in part by the Agency for Healthcare Research and Quality (HS17775).
See "Nystagmus assessments documented by emergency physicians in acute dizziness presentations: A target for decision support?" by Kevin A. Kerber, M.D., Lewis B. Morgenstern, M.D., William J. Meurer, M.D., and others in the 2011 Academic Emergency Medicine 18, pp. 619-626.
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