Evidence Based Best Care Practice for Benign Paroxysmal Positional Vertigo

NCT02809599 | Completed

• 2 other identifiers: HUM00109306R01DC012760
• Study Type: interventional
• Target: 7,635
• Locations: 0 countries
• Sites: N/A

Brief Summary

The study evaluates a theory-based educational intervention and implementation strategy on the use of the Dix-Hallpike test (DHT) and Canalith Repositioning Maneuver (CRM) in a community Emergency Department (ED) setting. The DHT and CRM are used to diagnose and treat Benign Paroxysmal Positional Vertigo (BPPV).

Conditions

Benign Paroxysmal Positional Vertigo

Keywords

vertigo; dizziness

Outcome Measures

Primary Outcomes (1)

• Likelihood of Receiving a BPPV Care Process

  Pre-intervention (no intervention) vs. post-intervention (under intervention).The primary endpoint is measured at the individual patient level, and is the presence of documentation of either the Dix-Hallpike test, the Epley Maneuver (or CRM) (since the first step of the CRM is the diagnostic maneuver).

  Index ED Visit (within hours to 2 days)

Secondary Outcomes (2)

• Outpatient Referral to a BPPV Provider

  Index ED Visit (within hours to 2 days)

• 90-day Cumulative Incidence of Stroke

  90 days following initial ED discharge home visit for dizziness

Other Outcomes (4)

• Stroke at Index ED Dizziness Visit

  Index ED Visit (within hours to 2 days)

• ED Length of Stay

  Index ED Visit (within hours to 2 days)

• Neuroimaging utilization

  Index ED Visit (within hours to 2 days)

Study Arms (2)

Pre-intervention

NO INTERVENTION

Patients in hospitals that have not received the intervention (DIZZTINCT) and that meet eligibility criteria will have their medical charts abstracted to assess BPPV processes at the ED Index visit. A random sample of these patients will be contacted by phone for a brief phone interview regarding their recent visit to the Emergency Department for dizziness.

Post-intervention

EXPERIMENTAL

Patients in hospitals that have received the intervention (DIZZTINCT) and that meet eligibility criteria will have their medical charts abstracted to assess the main study outcome, behavior change in medical providers. A random sample of these patients will be contacted by phone for a brief phone interview regarding their recent visit to the Emergency Department for dizziness.

Behavioral: DIZZTINCT

Interventions

DIZZTINCT BEHAVIORAL

The intervention, DIZZTINCT, is a multi-faceted educational and care-process based intervention designed to improve the guideline-concordant care of patients with BPPV in the emergency department. The intervention includes six main components: the recruitment and training of local champions who will serve as colleague experts in the community; interactive hands-on educational sessions that address BPPV mechanisms, evidence and practice; a high-yield decision-aid web application for self study and point of care use; development of a referral network for follow up care; follow-up educational sessions to review successes and barriers amongst the intervention group; and other resources developed locally in partnership with the community medical providers.

Post-intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ED patient seen at one of six full service non-freestanding Emergency Departments in Nueces County, Texas
• Principal dizziness case: the triage reason for visit is a dizziness symptom OR a dizziness symptom is one of first three listed complaints in physician medical record OR a dizziness diagnosis (e.g., dizziness or vertigo NOS, BPPV, vestibular neuritis) is recorded as one of the first three final ED diagnoses.

You may not qualify if:

• none

Sponsors & Collaborators

• University of Michigan: lead
• National Institute on Deafness and Other Communication Disorders (NIDCD): collaborator

Related Publications (2)

• Kerber KA, Damschroder L, McLaughlin T, Brown DL, Burke JF, Telian SA, Tsodikov A, Fagerlin A, An LC, Morgenstern LB, Forman J, Vijan S, Rowell B, Meurer WJ. Implementation of Evidence-Based Practice for Benign Paroxysmal Positional Vertigo in the Emergency Department: A Stepped-Wedge Randomized Trial. Ann Emerg Med. 2020 Apr;75(4):459-470. doi: 10.1016/j.annemergmed.2019.09.017. Epub 2019 Dec 20.

  PMID: 31866170 DERIVED

• Meurer WJ, Beck KE, Rowell B, Brown D, Tsodikov A, Fagerlin A, Telian SA, Damschroder L, An LC, Morgenstern LB, Ujhely M, Loudermilk L, Vijan S, Kerber KA. Implementation of evidence-based practice for benign paroxysmal positional vertigo: DIZZTINCT- A study protocol for an exploratory stepped-wedge randomized trial. Trials. 2018 Dec 22;19(1):697. doi: 10.1186/s13063-018-3099-0.

  PMID: 30577834 DERIVED

MeSH Terms

Conditions

Benign Paroxysmal Positional Vertigo; Vertigo; Dizziness

Condition Hierarchy (Ancestors)

Vestibular Diseases; Labyrinth Diseases; Ear Diseases; Otorhinolaryngologic Diseases; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Sensation Disorders

Study Officials

• Kevin A Kerber, MD

  University of Michigan

  PRINCIPAL INVESTIGATOR

• William Meurer, MD

  University of Michigan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: June 16, 2016
• First Posted: June 22, 2016
• Study Start: October 13, 2016
• Primary Completion: April 14, 2018
• Study Completion: April 16, 2018
• Last Updated: April 18, 2019

Record last verified: 2019-04

Data Sharing

• IPD Sharing: Will not share