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Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms.

Kene MV, Ballard DW, Vinson DR, Rauchwerger AS, Iskin HR, Kim AS - West J Emerg Med (2015)

Bottom Line: A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively).Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.

View Article: PubMed Central - PubMed

Affiliation: The Permanente Medical Group ; Kaiser Permanente Fremont Medical Center, Department of Emergency Medicine, Fremont, California.

ABSTRACT

Introduction: We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients.

Methods: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule.

Results: The response rate was 68% (366/535). Respondents' median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.

Conclusion: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.

No MeSH data available.


Related in: MedlinePlus

Agreement with feeling confidence in use of specific diagnostic aids and history and exam elementsa.aSurvey question 4, a-g, statement iiHINTS-Head impulse, nystagmus, test of skewABCD2-to predict 30 day risk of stroke after transient ischemic attack
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f3-wjem-16-768: Agreement with feeling confidence in use of specific diagnostic aids and history and exam elementsa.aSurvey question 4, a-g, statement iiHINTS-Head impulse, nystagmus, test of skewABCD2-to predict 30 day risk of stroke after transient ischemic attack

Mentions: Respondents’ agreement with statements about self-reported use of and confidence in using bedside diagnostic and physical examination findings and a commonly used clinical prediction rule for TIA (ABCD2) is shown in Figure 2. Confidence in applying these bedside diagnostic and physical exam tests and how often they were applied is reported in Figure 3. Respondents reported the lowest confidence in and likelihood of applying Dix-Hallpike and HINTS testing of the queried elements.


Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms.

Kene MV, Ballard DW, Vinson DR, Rauchwerger AS, Iskin HR, Kim AS - West J Emerg Med (2015)

Agreement with feeling confidence in use of specific diagnostic aids and history and exam elementsa.aSurvey question 4, a-g, statement iiHINTS-Head impulse, nystagmus, test of skewABCD2-to predict 30 day risk of stroke after transient ischemic attack
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644052&req=5

f3-wjem-16-768: Agreement with feeling confidence in use of specific diagnostic aids and history and exam elementsa.aSurvey question 4, a-g, statement iiHINTS-Head impulse, nystagmus, test of skewABCD2-to predict 30 day risk of stroke after transient ischemic attack
Mentions: Respondents’ agreement with statements about self-reported use of and confidence in using bedside diagnostic and physical examination findings and a commonly used clinical prediction rule for TIA (ABCD2) is shown in Figure 2. Confidence in applying these bedside diagnostic and physical exam tests and how often they were applied is reported in Figure 3. Respondents reported the lowest confidence in and likelihood of applying Dix-Hallpike and HINTS testing of the queried elements.

Bottom Line: A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively).Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.

View Article: PubMed Central - PubMed

Affiliation: The Permanente Medical Group ; Kaiser Permanente Fremont Medical Center, Department of Emergency Medicine, Fremont, California.

ABSTRACT

Introduction: We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients.

Methods: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule.

Results: The response rate was 68% (366/535). Respondents' median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.

Conclusion: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.

No MeSH data available.


Related in: MedlinePlus