Acute vestibular syndrome: a critical review and diagnostic algorithm concerning the clinical differentiation of peripheral versus central aetiologies in the emergency department

2016 ◽  
Vol 263 (11) ◽  
pp. 2151-2157 ◽  
Author(s):  
J. Venhovens ◽  
J. Meulstee ◽  
W. I. M. Verhagen
Keyword(s):  
Emergency Department ◽  
Critical Review ◽  
Diagnostic Algorithm ◽  
Acute Vestibular Syndrome

scholarly journals 004 Vestibular event monitoring in the emergency department

2019 ◽  
Vol 90 (e7) ◽  
pp. A2.1-A2
Author(s):  
Benjamin Nham ◽  
Nicole Reid ◽  
Emma Argaet ◽  
Allison Young ◽  
Kendall Bein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Assessment ◽  
Vestibular Migraine ◽  
Slow Phase ◽  
Control Group ◽  
Event Monitoring ◽  
Horizontal Canal ◽  
Posterior Canal ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome

IntroductionAcute vertigo is often accompanied by ictal-nystagmus which may assist with diagnosis. We examine the merits of a structured assessment combined with vestibular event-monitoring in the Emergency Department (ED).MethodsWe undertook a structured clinical assessment and video-nystagmography in 220 non-consecutive patients presenting to a public-hospital ED with acute vertigo, during a 10-month period. The records of 115 consecutive vertiginous patients who underwent standard-assessment were compared.ResultsFor the structured assessment group: 54% presented with acute vestibular syndrome (AVS), 24% with episodic spontaneous vertigo (EVS), and 20% with recurrent positional-vertigo (RPV).For AVS (n=119), most common diagnoses were vestibular neuritis (34%), stroke (34%) and vestibular migraine (13%). Nystagmus slow-phase velocity (SPV) for VN, stroke and VM were 11±5.5o/s, 5.6±2.5o/s, 5.4±5.9o/s; Mean ipsilesional video-head impulse gains were 0.51±0.29, 0.89±0.20 and 0.96±0.13. For EVS(n=53), diagnoses included vestibular migraine (63%), Meniere’s Disease (11%) and others (26%). Nystagmus SPV was 5.4±3.6o/s, 7.6±6.3o/s, 4.1±1.5o/s. In RPV (n=43), common diagnoses were posterior-canal BPPV (66%), horizontal-canal BPPV (23%), migraine (7%). Positional nystagmus SPV profile showed Peak SPV of 42.5o/s, 77.6o/s, 20.64o/s and Time-constants of 6.52s, 22.51s, 34.56s for Posterior-canal BPPV, Horizontal-canal BPPV and Atypical Positional-Vertigo. A final diagnosis was reached in 96% of patients.In the ED control group, only 77% were separated into spontaneous or positional-vertigo. A diagnosis was provided in 57% and was concordant with the history and examination in 34%.ConclusionVestibular event-monitoring and structured clinical assessment secured a diagnosis in 96% of cases compared with 34% for the control group, reinforcing its merit.

Dizziness and the Acute Vestibular Syndrome at the Emergency Department: A Population-Based Descriptive Study

2017 ◽  
Vol 79 (1-2) ◽  
pp. 5-12 ◽  
Author(s):  
Micaela Ljunggren ◽  
Julia Persson ◽  
Jonatan Salzer
Keyword(s):  
Emergency Department ◽  
Descriptive Study ◽  
Population Based ◽  
Acute Vestibular Syndrome

LO91: Urinary tract infections in the paediatric emergency department: A quality improvement initiative to promote diagnostic and antimicrobial stewardship

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S41
Author(s):  
V. Singh ◽  
L. Morrissey ◽  
M. Science ◽  
O. Ostrow
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Urine Culture ◽  
Diagnostic Algorithm ◽  
Antimicrobial Treatment ◽  
Stewardship Program ◽  
Common Diagnosis ◽  
Negative Urine Culture ◽  
Tract Infections

Background: Urinary tract infection (UTI) is a common diagnosis in children presenting to the Emergency Department (ED) and often leads to empiric antibiotic treatment prior to culture results. A recent study at our centre found that 47% of children diagnosed with a UTI and discharged on antibiotics had a negative urine culture. None of these patients were notified of the negative result or to discontinue antimicrobial treatment. Aim Statement: The aim of this study was to improve UTI diagnostic accuracy by 50% while promoting antimicrobial stewardship through timely antibiotic discontinuation and standardized antimicrobial treatment for uncomplicated UTIs over the next 12 months. Measures & Design: Three interventions were developed using plan-do-study-act (PDSA) cycles. In collaboration with the hospital's Choosing Wisely campaign and antimicrobial stewardship program, an evidence-based empiric UTI diagnostic algorithm was created to aid with diagnostic decision-making and reduce practice variation. A daily call-back system was also implemented for urine cultures where patients who had a negative urine culture were contacted to stop antibiotics. Lastly, a practice alert was integrated in the EMR as a reminder of appropriate antimicrobial prescription duration. The main outcome measures were the percentage of inappropriately diagnosed UTIs and percentage with timely antimicrobial discontinuation. Process measures included antibiotic days saved, treatment duration, and physician adherence to the algorithm. As a balancing measure, positive urine cultures were reviewed to assess accuracy of the algorithm to detect UTIs and potential harm from delayed UTI diagnoses. Evaluation/Results: Early results from the 530 children included in the analysis demonstrated a 14% reduction in inappropriate UTI diagnoses. With the initiation of the call-back system, the antibiotic days saved increased from 0 to 495 days. Call-backs for negative cultures increased from 0% to 68% of the time. Of those positive cultures with a missed UTI diagnosis, only 5 patients in 5 months had a return visit within 72 hours and none required admission. Discussion/Impact: Appropriate diagnosis and treatment of UTIs in our ED has improved with the implementation of a diagnostic algorithm. A larger impact is anticipated once the algorithm is embedded in the EMR as a form of decision support, but these changes take time to implement. Although labour intensive, the call-back system has greatly impacted the antimicrobial days saved and reduced risk for harm in this population.

Response to Letter to the Editor
The Contribution of the Emergency Department to Opioid Pain Reliever Misuse and Diversion: A Critical Review

Pain Practice ◽  
2017 ◽  
Vol 17 (8) ◽  
pp. 1123-1123 ◽  
Author(s):  
Tatyana Lyapustina ◽  
Renan Castillo ◽  
Elise Omaki ◽  
Wendy Shields ◽  
Eileen McDonald ◽  
...  
Keyword(s):  
Emergency Department ◽  
Critical Review ◽  
Pain Reliever ◽  
Letter To The Editor

scholarly journals Diagnostic anticipation to reduce emergency department length of stay: a cohort study in Ferrara University Hospital, Italy

2020 ◽  
Author(s):  
Andrea Strada ◽  
Niccolò Bolognesi ◽  
Lamberto Manzoli ◽  
Giorgia Valpiani ◽  
Chiara Morotti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Abdominal Pain ◽  
Chest Pain ◽  
Length Of Stay ◽  
Diagnostic Algorithm ◽  
University Hospital ◽  
Blood Tests ◽  
Traumatic Bleeding ◽  
Ed Crowding

Abstract Background : Emergency Department (ED) crowding reduces staff satisfaction and healthcare quality and safety, which in turn increase costs. Despite a number of proposed solutions, ED length of stay (LOS) - a main cause of overcrowding - remains a major issue worldwide. This cohort study was aimed at evaluating the effectiveness on ED LOS of a procedure called “diagnostic anticipation”, which consisted in anticipating the ordering of blood tests by nurses, at triage, following a diagnostic algorithm approved by physicians. Methods : In the second half of 2019, the ED of the University Hospital of Ferrara, Italy, adopted the diagnostic anticipation protocol on alternate weeks for all patients with chest pain, abdominal pain, and non-traumatic bleeding. Using ED electronic data, LOS independent predictors were evaluated through multiple regression. Results : During the weeks when diagnostic anticipation was adopted, as compared to control weeks, the mean LOS was shorter by 18.2 minutes for chest pain, but longer by 15.7 minutes for abdominal pain, and 33.3 for non-traumatic bleeding. At multivariate analysis, adjusting for age, gender, triage priority and ED crowding, the difference in visit time was significant for chest pain only (p<0.001). Conclusions : The effectiveness of the anticipation of blood testing by nurses varied by patients' condition, being significant for chest pain only. Further research is needed before the implementation, estimating the potential proportion of inappropriate blood tests and ED crowding status

scholarly journals Unmasking aortic dissection in patients of transient global amnesia: case report and diagnostic algorithm for the emergency department

2011 ◽  
Vol 2011 (jan20 1) ◽  
pp. bcr0720103151-bcr0720103151 ◽  
Author(s):  
M. Colotto ◽  
M. Maranghi ◽  
A. Epifania ◽  
M. Totaro ◽  
R. Giura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Aortic Dissection ◽  
Diagnostic Algorithm ◽  
Transient Global Amnesia ◽  
Global Amnesia
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