Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey.
Identifieur interne : 000052 ( Main/Corpus ); précédent : 000051; suivant : 000053Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey.
Auteurs : Kenji Numata ; Takashi Shiga ; Kazuhiro Omura ; Akiko Umibe ; Eiji Hiraoka ; Shunsuke Yamanaka ; Hiroyuki Azuma ; Yasuhiro Yamada ; Daiki KobayashiSource :
- PloS one [ 1932-6203 ] ; 2019.
English descriptors
- KwdEn :
- Acute Disease (MeSH), Female (MeSH), Head Impulse Test (MeSH), Humans (MeSH), Male (MeSH), Metoclopramide (therapeutic use), Multivariate Analysis (MeSH), Otolaryngologists (psychology), Sodium Bicarbonate (therapeutic use), Surveys and Questionnaires (MeSH), Tomography, X-Ray Computed (MeSH), Vertigo (diagnosis), Vertigo (drug therapy).
- MESH :
- chemical , therapeutic use : Metoclopramide, Sodium Bicarbonate.
- diagnosis : Vertigo.
- drug therapy : Vertigo.
- psychology : Otolaryngologists.
- Acute Disease, Female, Head Impulse Test, Humans, Male, Multivariate Analysis, Surveys and Questionnaires, Tomography, X-Ray Computed.
Abstract
Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07-0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06-0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01-5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07-0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01-0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85-61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.
DOI: 10.1371/journal.pone.0213196
PubMed: 30845218
PubMed Central: PMC6405109
Links to Exploration step
pubmed:30845218Le document en format XML
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Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Shiga, Takashi" sort="Shiga, Takashi" uniqKey="Shiga T" first="Takashi" last="Shiga">Takashi Shiga</name><affiliation><nlm:affiliation>Department of Emergency Medicine, International University of Health and Welfare, Mita hospital, Mita, Minato-ku Tokyo, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Omura, Kazuhiro" sort="Omura, Kazuhiro" uniqKey="Omura K" first="Kazuhiro" last="Omura">Kazuhiro Omura</name><affiliation><nlm:affiliation>Department of Otorhinolaryngology, The Jikei University School of Medicine, Nishi-shimbashi, Minato-ku, Tokyo, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Umibe, Akiko" sort="Umibe, Akiko" uniqKey="Umibe A" first="Akiko" last="Umibe">Akiko Umibe</name><affiliation><nlm:affiliation>Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Minamikoshigaya, Koshigaya city, Saitama, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Hiraoka, Eiji" sort="Hiraoka, Eiji" uniqKey="Hiraoka E" first="Eiji" last="Hiraoka">Eiji Hiraoka</name><affiliation><nlm:affiliation>Department of General Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Yamanaka, Shunsuke" sort="Yamanaka, Shunsuke" uniqKey="Yamanaka S" first="Shunsuke" last="Yamanaka">Shunsuke Yamanaka</name><affiliation><nlm:affiliation>Department of Emergency Medicine, University of Fukui Hospital, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Azuma, Hiroyuki" sort="Azuma, Hiroyuki" uniqKey="Azuma H" first="Hiroyuki" last="Azuma">Hiroyuki Azuma</name><affiliation><nlm:affiliation>Department of Emergency Medicine, Fukui prefectural hospital, Fukui, Fukui prefecture, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Yamada, Yasuhiro" sort="Yamada, Yasuhiro" uniqKey="Yamada Y" first="Yasuhiro" last="Yamada">Yasuhiro Yamada</name><affiliation><nlm:affiliation>Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, higashigaoka, meguro-ku, Tokyo, Japan.</nlm:affiliation></affiliation></author><author><name sortKey="Kobayashi, Daiki" sort="Kobayashi, Daiki" uniqKey="Kobayashi D" first="Daiki" last="Kobayashi">Daiki Kobayashi</name><affiliation><nlm:affiliation>Division of General Internal Medicine, St. Luke's International Hospital, Tokyo Japan.</nlm:affiliation></affiliation></author></analytic><series><title level="j">PloS one</title><idno type="eISSN">1932-6203</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Disease (MeSH)</term><term>Female (MeSH)</term><term>Head Impulse Test (MeSH)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Metoclopramide (therapeutic use)</term><term>Multivariate Analysis (MeSH)</term><term>Otolaryngologists (psychology)</term><term>Sodium Bicarbonate (therapeutic use)</term><term>Surveys and Questionnaires (MeSH)</term><term>Tomography, X-Ray Computed (MeSH)</term><term>Vertigo (diagnosis)</term><term>Vertigo (drug therapy)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Metoclopramide</term><term>Sodium Bicarbonate</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Vertigo</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Vertigo</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Otolaryngologists</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Acute Disease</term><term>Female</term><term>Head Impulse Test</term><term>Humans</term><term>Male</term><term>Multivariate Analysis</term><term>Surveys and Questionnaires</term><term>Tomography, X-Ray Computed</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07-0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06-0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01-5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07-0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01-0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85-61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">30845218</PMID><DateCompleted><Year>2019</Year><Month>12</Month><Day>03</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>09</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1932-6203</ISSN><JournalIssue CitedMedium="Internet"><Volume>14</Volume><Issue>3</Issue><PubDate><Year>2019</Year></PubDate></JournalIssue><Title>PloS one</Title><ISOAbbreviation>PLoS One</ISOAbbreviation></Journal><ArticleTitle>Comparison of acute vertigo diagnosis and treatment practices between otolaryngologists and non-otolaryngologists: A multicenter scenario-based survey.</ArticleTitle><Pagination><MedlinePgn>e0213196</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0213196</ELocationID><Abstract><AbstractText>Acute vertigo is a common problem in emergency departments. However, clinical strategies of acute vertigo care vary among care providers. The aim of the study was to investigate differences in diagnosis [Dix-Hallpike test, the head impulse, nystagmus, and the test of skew (HINTS) procedure, and imaging modalities] and treatment (pharmacological treatments and the Epley maneuver) by otolaryngologists and non-otolaryngologists in emergency medicine settings. We used a multicenter case-based survey for the study. Four clinical vignettes of acute vertigo (posterior canal benign paroxysmal positional vertigo, vestibular neuritis, Meniere disease, and nonspecific vertigo) were used. Total 151 physicians from all study sites participated in the study. There were 84 non-otolaryngologists (48 emergency physicians and 36 internists) and 67 otolaryngologists. The multivariate analysis indicated that otolaryngologists ordered fewer CT scans (odds ratio (OR), 0.20; 95% confidence interval (CI), 0.07-0.53) and performed fewer HINTS procedures (OR, 0.17; 95% CI, 0.06-0.46), but used the Dix-Hallpike method more often (OR, 2.36; 95% CI, 1.01-5.52) for diagnosis compared to non-otolaryngologists. For treatment, otolaryngologists were less likely to use the Epley method (OR, 0.19; 95% CI, 0.07-0.53) and metoclopramide (OR, 0.09; 95% CI, 0.01-0.97) and more likely to use sodium bicarbonate (OR, 20.50; 95% CI, 6.85-61.40) compared to non-otolaryngologists. We found significant differences in the acute vertigo care provided by non-otolaryngologists and otolaryngologists from a vignette-based research. To improve acute vertigo care, educational systems focusing on acute vertigo are needed.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Numata</LastName><ForeName>Kenji</ForeName><Initials>K</Initials><Identifier Source="ORCID">0000-0001-9813-5592</Identifier><AffiliationInfo><Affiliation>Department of Emergency Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shiga</LastName><ForeName>Takashi</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Emergency Medicine, International University of Health and Welfare, Mita hospital, Mita, Minato-ku Tokyo, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Omura</LastName><ForeName>Kazuhiro</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Department of Otorhinolaryngology, The Jikei University School of Medicine, Nishi-shimbashi, Minato-ku, Tokyo, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Umibe</LastName><ForeName>Akiko</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Minamikoshigaya, Koshigaya city, Saitama, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hiraoka</LastName><ForeName>Eiji</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of General Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Todaijima, Urayasu city, Chiba, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yamanaka</LastName><ForeName>Shunsuke</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Emergency Medicine, University of Fukui Hospital, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Azuma</LastName><ForeName>Hiroyuki</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Emergency Medicine, Fukui prefectural hospital, Fukui, Fukui prefecture, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yamada</LastName><ForeName>Yasuhiro</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, higashigaoka, meguro-ku, Tokyo, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kobayashi</LastName><ForeName>Daiki</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Division of General Internal Medicine, St. Luke's International Hospital, Tokyo Japan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>03</Month><Day>07</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS One</MedlineTA><NlmUniqueID>101285081</NlmUniqueID><ISSNLinking>1932-6203</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>8MDF5V39QO</RegistryNumber><NameOfSubstance UI="D017693">Sodium Bicarbonate</NameOfSubstance></Chemical><Chemical><RegistryNumber>L4YEB44I46</RegistryNumber><NameOfSubstance UI="D008787">Metoclopramide</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000208" MajorTopicYN="N">Acute Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D064087" MajorTopicYN="N">Head Impulse Test</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008787" MajorTopicYN="N">Metoclopramide</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015999" MajorTopicYN="N">Multivariate Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000072220" MajorTopicYN="Y">Otolaryngologists</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017693" MajorTopicYN="N">Sodium Bicarbonate</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011795" MajorTopicYN="N">Surveys and Questionnaires</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014057" MajorTopicYN="N">Tomography, X-Ray Computed</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014717" MajorTopicYN="N">Vertigo</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading></MeshHeadingList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year><Month>10</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>02</Month><Day>16</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>3</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>3</Month><Day>8</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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