Clinical assessment and management of patients presenting to the emergency departments of a metropolitan health service with vertigo, dizziness or imbalance

Ms Melanie Lloyd1, Ms Alexandra Mackintosh1, Ms  Catherine Grant1, Dr Clarice Tang2

1Western Health, St Albans, Australia

2La Trobe University, Bundoora, Australia 

Aim: To determine the proportion of patients: 1) presenting with symptoms of dizziness, vertigo or imbalance, who were assessed and managed in accordance with published clinical practice guidelines for BPPV, 2) with a positive diagnostic test for BPPV, and 3) who were discharged without a clear cause for symptoms identified.

Method: This is a retrospective study conducted across three acute hospitals within a metropolitan health service. All adults (age ≥18) who presented to the ED with symptoms of vertigo, dizziness or imbalance were included. Upon identification, comprehensive review of the patient’s medical history was conducted to identify the clinical assessment and management received during the presentation.

Results: A total of 96 patients were included in this study. More than half (55%) of participants’ symptoms were potentially attributable to a vestibular cause, of which 4% had a positive diagnostic test for BPPV.  For these patients, CT scans were the most common assessment tool (37%) while gold standard clinical tests were rarely used. Patients were often prescribed with vestibular suppressants (61%) in contradiction to published clinical guidelines, and were infrequently (6%) treated with the recommended canalith-repositioning technique.

Significance of findings to allied health: Patients with symptoms of dizziness, vertigo or imbalance present frequently to the ED. Current clinical management of these patients often contradicts published clinical guidelines, and it is likely that BPPV is under-diagnosed. Physiotherapy services should investigate novel ways to address the translation gap in evidence-based management of BPPV.