Abstract
Distinguishing between serious (e.g., stroke) and benign (e.g., benign paroxysmal positional vertigo, BPPV) disorders remains challenging in emergency consultations for vertigo and dizziness (VD). A number of clues from patient history and clinical examination, including several diagnostic index tests have been reported recently. The objective of the present study was to analyze frequency and distribution patterns of specific vestibular and non-vestibular diagnoses in an interdisciplinary university emergency room (ER), including data on daytime and season of presentation. A retrospective chart analysis of all patients seen in a one-year period was performed. In the ER 4.23% of all patients presented with VD (818 out of 19,345). The most frequent-specific diagnoses were BPPV (19.9%), stroke/transient ischemic attack (12.5%), acute unilateral vestibulopathy/vestibular neuritis (UVH; 8.3%), and functional VD (8.3%). Irrespective of the diagnosis, the majority of patients presented to the ER between 8 a.m. and 4 p.m. There are, however, seasonal differences. BPPV was most prevalent in December/January and rare in September. UVH was most often seen in October/November; absolute and relative numbers were lowest in August. Finally, functional/psychogenic VD was common in summer and autumn with highest numbers in September/October and lowest numbers in March. In summary, daytime of presentation did not distinguish between diagnoses as most patients presented during normal working hours. Seasonal presentation revealed interesting fluctuations. The UVH peak in autumn supports the viral origin of the condition (vestibular neuritis). The BPPV peak in winter might be related to reduced physical activity and low vitamin D. However, it is likely that multiple factors contribute to the fluctuations that have to be disentangled in further studies.
Highlights
Patients presenting to the emergency room (ER) must be diagnosed quickly to identify those needing urgent treatment [35]
Vertigo and dizziness (VD) may present as acute vestibular syndrome (AVS) in unilateral vestibular dysfunction, but other diagnoses have to be kept in mind from benign paroxysmal positional vertigo (BPPV) to anxiety related dizziness [29]
For the current study we asked the following questions: (1) which patient groups present to the ER and how does the spectrum of disorders differ between ER and a tertiary care outpatient dizziness clinic?; (2) how is the usage of diagnostic/imaging procedures to differentiate between benign and serious causes of VD?; and (3) does the seasonal and circadian distribution of presentation differ between diagnoses? To address these questions, we performed a retrospective chart analysis of all non-surgical patients presenting in a 1-year period to the ER of a tertiary care university hospital in Germany
Summary
Patients presenting to the emergency room (ER) must be diagnosed quickly to identify those needing urgent treatment [35]. For the current study we asked the following questions: (1) which patient groups present to the ER and how does the spectrum of disorders differ between ER and a tertiary care outpatient dizziness clinic?; (2) how is the usage of diagnostic/imaging procedures to differentiate between benign and serious causes of VD?; and (3) does the seasonal and circadian distribution of presentation differ between diagnoses? We hypothesized to see (1) more AVS patients compared to a tertiary care dizziness clinic in the ER; (2) a high number of diagnostic imaging without any pathologic correlate; and (3) a peak of benign paroxysmal positional vertigo (BPPV) in morning hours, presentation of stroke/transitoric ischemic attack (TIA) without specific circadian peaks, and a seasonal preponderance of vestibular neuritis (UVH) in spring and autumn because of the suspected viral etiology
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