Objective: To evaluate a strategy to increase use of the test (Dix-Hallpike test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for Benign Paroxysmal Positional Vertigo (BPPV) in emergency department (ED) dizziness visits. Methods: We conducted a stepped-wedge randomized trial in six EDs. The population was visits with dizziness as a principal reason for the visit. The intervention included educational sessions and decision aid materials. Outcomes were DHT or CRM documentation (primary), head CT use, length-of-stay, admission, and 90-day stroke events. The analysis was multi-level logistic regression with intervention, month, and hospital as fixed effects, and provider as a random effect. We assessed fidelity with monitoring intervention use and semi-structured interviews. Results: We identified 7,635 dizziness visits over 18 months. The DHT or CRM was documented in 1.5% of control visits (45/3077; 95% CI, 1%-1.9%) and 3.5% of intervention visits (159/4558; 95% CI, 3%-4%; difference 2% 95% CI, 1.3%, 2.7%). Head CT use was lower in intervention visits compared with controls (44.0% [1352/3077] vs 36.9% [1682/4558]). No differences were observed in admission or 90-day subsequent stroke risk. In fidelity evaluations, providers who used the materials typically reported positive clinical experiences but provider engagement was low at facilities without an emergency medicine residency program. Conclusions: These findings provide evidence that an implementation strategy of a BPPV-focused approach to ED dizziness visits can be successful and safe in promoting evidence-based care. Absolute rates of DHT and CRM use, however, were still low which relates in part to our broad inclusion criteria for dizziness visits.
Head‐Up Sleep May Cure Patients With Intractable Benign Paroxysmal Positional Vertigo: A six‐Month Randomized Trial
