Accuracy and rEliabilitY of the vEstibuLo-ocular ExAmination Performed by inteRNs IN the emerGency Department

NCT04919187 | Completed

• 1 other identifier: EYE LEARNING
• Study Type: observational
• Target: 321
• Locations: 1 country
• Sites: 1

Brief Summary

Dizziness, loss of balance, and unsteadiness of gait are common symptoms reported by Emergency Department (ED) patients. The incidence of acute vestibular syndrome (AVS) is increasing and reaches 2-4% of ED visits. In the ED of the Paris Saint Joseph Hospital Group, its incidence was 5% during the year 2019 and 2% during the year 2020 (COVID-19 pandemic period). Emergency medicine is based on a dichotomous principle for any acute pathology in the initial phase. For AVS, the diagnostic dilemma for emergency physicians is usually to differentiate a benign vestibular cause from a potentially serious cerebral cause such as ischemic stroke of the vertebro-basilar territory. The majority of AVS are related to acute vestibulopathies, yet it is necessary to recognize and distinguish a benign paroxysmal positional vertigo (BPPV) from a vestibular neuritis, a vestibular migraine, or a labyrinthine hydrops, to exclude with certainty a cerebral involvement. However, posterior fossa strokes mimic 5% of BPPV and 25% of vestibular neuritis. Among these strokes, about 20% are therefore revealed by a VAS without associated localizing neurological sign. In the absence of a clear neurological sign, the emergency physician must therefore decide whether to treat the patient as an outpatient when he or she suspects a AVS of "peripheral" origin (otolaryngology), or as an inpatient when he or she suspects a "central" origin, in particular a stroke.

Conditions

Acute Vestibular Syndrome; Emergencies

Outcome Measures

Primary Outcomes (1)

• To determine the diagnostic accuracy of the STANDING algorithm performed by ED medical student to distinguish central from peripheral causes of isolated AVS in the ED.

  Sensitivity and specificity of the STANDING algorithm performed by ED medical student.

  Day 1

Secondary Outcomes (2)

• To determine the inter-rater reliability of each items of the STANDING algorithm, between an ED medical student and a senior emergency physician for each patient.

  Day 1

• To evaluate the changing opinions of ED medical students on vestibulo-ocular examination between the beginning and the end of their internship in the ED

  Day 1

Eligibility Criteria

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

Study Population

This is a prospective diagnostic monocentric cohort study. These patients consulted the SU for symptoms integrated in an isolated AVS, i.e.: vertigo, balance disorder, instability on walking, present for at least one hour and less than one week, as defined by the Barany Society. The study will be reported using the STARD Statement criteria.

You may qualify if:

• Patient whose age is ≥ 18 years
• French-speaking patient.
• Patient presenting on admission to the emergency department with an isolated AVS defined by a course of more than one hour and less than one week and the presence of at least one symptom among:
• vertigo: an illusion of displacement of the subject in relation to surrounding objects or surrounding objects in relation to the subject, a sensation of rotation, displacement of the body in the vertical plane, instability described as pitching or as a "spinning head", sometimes associated with vegetative signs (nausea, vomiting, pallor, sweating, slowing of the heart rate)
• and/or spontaneous or positional nystagmus,
• and/or a gait disorder: such as imbalance with lurching, or a shaky gait, or simple instability.
• A patient may be included several times during the study period provided that they are distinct acute episodes of isolated AVS.

You may not qualify if:

• Patient under guardianship or curatorship
• Patient deprived of liberty
• Patient under court protection
• Patient objecting to the use of his/her data for this research
• Patient with focal neurological signs concomitant with AVS: a language or writing disorder, a speech disorder such as dysarthria, a disorder in the execution of voluntary movements, a sensory, motor or visual deficit, involuntary abnormal movements
• Patient with a history of oculomotor paralysis.

Sponsors & Collaborators

• Fondation Hôpital Saint-Joseph: lead

Study Sites (1)

Groupe Hospitalier Paris Saint Joseph

Paris, Île-de-France Region, 75014, France

Location

Related Publications (1)

• Gerlier C, Fels A, Vitaux H, Mousset C, Perugini A, Chatellier G, Ganansia O. Effectiveness and reliability of the four-step STANDING algorithm performed by interns and senior emergency physicians for predicting central causes of vertigo. Acad Emerg Med. 2023 May;30(5):487-500. doi: 10.1111/acem.14659. Epub 2023 Jan 30.

  PMID: 36628557 RESULT

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Camille GERLIER, MD

  Fondation Hôpital Saint-Joseph

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 30, 2021
• First Posted: June 9, 2021
• Study Start: May 7, 2021
• Primary Completion: June 3, 2022
• Study Completion: September 21, 2022
• Last Updated: April 27, 2023

Record last verified: 2023-04

Locations

FR (1)