Abstract
BackgroundAcute dizziness, vertigo and imbalance are common symptoms in emergency departments. Stroke needs to be distinguished from vestibular diseases. A battery of three clinical bedside tests (HINTS: Head Impulse Test, Nystagmus, Test of Skew) has been shown to detect stroke as underlying cause with high reliability, but implementation is challenging in primary care hospitals. Aim of this study is to prove the feasibility of a telemedical HINTS examination via a remotely controlled videooculography (VOG) system.MethodsThe existing video system of our telestroke network TEMPiS (Telemedic Project for Integrative Stroke Care) was expanded through a VOG system. This feature enables the remote teleneurologist to assess a telemedical HINTS examination based on inspection of eye movements and quantitative video head impulse test (vHIT) evaluation. ED doctors in 11 spoke hospitals were trained in performing vHIT, nystagmus detection and alternating cover test. Patients with first time acute dizziness, vertigo or imbalance, whether ongoing or resolved, presented to the teleneurologist were included in the analysis, as long as no focal neurological deficit according to the standard teleneurological examination or obvious internal medicine cause was present and a fully trained team was available. Primary outcome was defined as the feasibility of the telemedical HINTS examination.ResultsFrom 01.06.2019 to 31.03.2020, 81 consecutive patients were included. In 72 (88.9%) cases the telemedical HINTS examination was performed. The complete telemedical HINTS examination was feasible in 46 cases (63.9%), nystagmus detection in all cases (100%) and alternating covert test in 70 cases (97.2%). The vHIT was recorded and interpretable in 47 cases (65.3%). Results of the examination with the VOG system yielded clear results in 21 cases (45.7%) with 14 central and 7 peripheral lesions. The main reason for incomplete examination was the insufficient generation of head impulses.ConclusionIn our analysis the telemedical HINTS examination within a telestroke network was feasible in two thirds of the patients. This offers the opportunity to improve specific diagnostics and therapy for patients with acute dizziness and vertigo even in primary care hospitals. Improved training for spoke hospital staff is needed to further increase the feasibility of vHIT.
Highlights
Vertigo and dizziness are among the most common symptoms in the emergency department (ED) with about 4% of emergency patients suffering from it [1]
Median duration of dizziness/vertigo symptoms was 313 (IQR 231–653) minutes with almost half of the patients suffering from nausea (n = 32; 44.4%)
Our prospective evaluation shows that telemedical Head Impulse Test (HINTS) examination can be performed successfully by trained staff via telemedicine in a relevant proportion of 63.9%
Summary
Vertigo and dizziness are among the most common symptoms in the emergency department (ED) with about 4% of emergency patients suffering from it [1]. About 4.4 million annual visits to emergency rooms in the United States of America are due to vertigo and dizziness [3]. A relevant portion of patients with dizziness and vertigo are misdiagnosed in the ED [4]. Failing to identify stroke as a cause of dizziness/vertigo has fatal consequences [5]. According to recent estimates about 4% to 10% of ED patients with dizziness and vertigo as leading symptoms have a stroke [6, 7] and misdiagnosis of peripheral vestibular failure is estimated to account for up to 60% of stroke cases during the initial classification of patients in the ED [5, 8, 9]. Vertigo and imbalance are common symptoms in emergency departments. Aim of this study is to prove the feasibility of a telemedical HINTS examination via a remotely controlled videooculography (VOG) system
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
