The Use of the Dix-Hallpike Test and the Canalith Repositioning Maneuver in Emergency Department Dizziness Presentations: A Population-Based Study (P02.250)

Abstract

Objective: To describe the use of the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM) in a population-based emergency department (ED) dizziness study. Background A common cause of dizziness, benign paroxysmal positional vertigo (BPPV), is effectively diagnosed with the DHT and treated with the CRM. No prior studies have assessed the use of these processes in ED dizziness presentations. Design/Methods: From January 15, 2008 to January 14, 2011, adult patients presenting to the ED in Nueces County, Texas, with dizziness, vertigo, or imbalance documented at triage were identified by review of ED logs, excluding those admitted to the hospital. Clinical information was abstracted from source documents. A hierarchical logistic regression model was fitted to estimate trends in DHT use and evaluate provider variability in DHT use. Results: 3,525 dizziness patients were identified. A DHT was documented in 137 visits (3.9%). The side tested was reported in 51 (37%). The DHT results were positive in 94 visits, negative in 37, and not documented in 6. Results were based on symptoms in 23, nystagmus in 21, and unknown in 93. None of the positive DHTs documented the characteristic pattern of BPPV nystagmus and only 47.9% (45 of 94) documented the affected side. A CRM was performed in only 8 visits. In the hierarchical model, every increase in month was associated with a 2% decrease in the use of the DHT (p=0.04), and the provider level explained more than 50% (ICC, 0.54) of the variance in DHT use. Conclusions: The DHT and CRM are used infrequently in this population. When documented, details about the technique and results are sparse. DHT use is decreasing over time, and varies substantially by provider. Implementation research focused on BPPV care may be an opportunity to optimize the efficiency and effectiveness of care in ED dizziness presentations. Supported by: NIHK23RR024009. Disclosure: Dr. Kerber has received personal compensation for activities with Munson Medical Center, Weinberg Group, Estes, Ingram, Foels & Gibbs as a speaker and/or consultant. Dr. Meurer has nothing to disclose. Dr. Brown has received compensation and/or their research work has been funded, entirely or in part, by a grant to their university. The grant agreement requires that the name of the funding entity and the purpose of the grant may not be disclosed. The funding entity is a governmental organization. Dr. Lisabeth has nothing to disclose. Dr. Callaghan has nothing to disclose. Dr. Fendrick has received personal compensation for activities with Abbott Laboratories, Inc., ActiveHealth Management, GlaxoSmithKline, Inc., Hewitt Associates, MedImpact HealthCare Systems Inc., Merck & Co., Inc., Novartis, and Perrigo as a consultant. Dr. Fendrick has received personal compensation in an editorial capacity for The American Journal of Managed Care. Dr. Fendrick has received research support from AstraZeneca Pharmaceuticals, Pfizer Inc, and Sanofi-Aventis Pharmaceuticals, Inc. Dr. Morgenstern has nothing to disclose.