Prospective study trial to increase the diagnostic accuracy of stroke among patients presenting to the emergency room with acute dizziness, vertigo and floating sensation -efficacy of "disequilibrium template"
Background and Purpose: We prepared and operated the "disequilibrium template" for non-specialists to increase the diagnostic accuracy of stroke among patients presenting to the emergency room with acute dizziness, vertigo or floating sensation. The purpose of this prospective study was to...
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| Published in | Japanese Journal of Stroke Vol. 35; no. 2; pp. 79 - 85 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japan Stroke Society
20.03.2013
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.35.79 |
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| Abstract | Background and Purpose: We prepared and operated the "disequilibrium template" for non-specialists to increase the diagnostic accuracy of stroke among patients presenting to the emergency room with acute dizziness, vertigo or floating sensation. The purpose of this prospective study was to examine the efficacy of the "disequilibrium template." Methods: Between January 2011 and December 2011, we conducted a prospective study of 487 patients who acutely complained dizziness, vertigo or floating sensation in the emergency room. Result: Stroke was diagnosed in 11.7% (57 of 487) of all patients with acute dizziness, vertigo or floating sensation. On admission, false-negative diffusion-weighted MRI was found in 10.5% (6 of 57) of patients with acute stroke. Nevertheless, we were able to diagnose stroke among all patients at the first visit to the emergency room. 66.5% (262 of 394) of patients without stroke diagnosed in the emergency room revisited as outpatient, and they were all reaffirmed without stroke. Using the "disequilibrium template" in the emergency room prevented us from overlooking stroke. Conclusions: This study revealed that the "disequilibrium template" is very simple and useful tool for increasing the diagnostic accuracy of stroke among patients with acute dizziness, vertigo or floating sensation. |
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| AbstractList | Background and Purpose: We prepared and operated the "disequilibrium template" for non-specialists to increase the diagnostic accuracy of stroke among patients presenting to the emergency room with acute dizziness, vertigo or floating sensation. The purpose of this prospective study was to examine the efficacy of the "disequilibrium template." Methods: Between January 2011 and December 2011, we conducted a prospective study of 487 patients who acutely complained dizziness, vertigo or floating sensation in the emergency room. Result: Stroke was diagnosed in 11.7% (57 of 487) of all patients with acute dizziness, vertigo or floating sensation. On admission, false-negative diffusion-weighted MRI was found in 10.5% (6 of 57) of patients with acute stroke. Nevertheless, we were able to diagnose stroke among all patients at the first visit to the emergency room. 66.5% (262 of 394) of patients without stroke diagnosed in the emergency room revisited as outpatient, and they were all reaffirmed without stroke. Using the "disequilibrium template" in the emergency room prevented us from overlooking stroke. Conclusions: This study revealed that the "disequilibrium template" is very simple and useful tool for increasing the diagnostic accuracy of stroke among patients with acute dizziness, vertigo or floating sensation. |
| Author | Hasegawa, Yasuhiro Hattori, Makoto Ito, Daisuke Noguchi, Yoshinori Yokoi, Satoshi Nakai, Noriyoshi Inada, Shinji Yasui, Keizo Nishi, Ryoji Mitsuma, Norimasa Kawabata, Kazuya Yamada, Shinichiro |
| Author_xml | – sequence: 1 fullname: Yasui, Keizo organization: Department of Neurology, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Kawabata, Kazuya organization: Department of Neurology, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Inada, Shinji organization: Department of Emergency, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Ito, Daisuke organization: Department of Neurology, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Mitsuma, Norimasa organization: Current address: Department of Neurology, Nagoya Daiichi Red Cross Hospital – sequence: 1 fullname: Hattori, Makoto organization: Department of Neurology, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Yokoi, Satoshi organization: Current address: Department of Neurology, Nagoya University Graduate School of Medicine – sequence: 1 fullname: Yamada, Shinichiro organization: Current address: Department of Neurology, Ogaki Municipal Hospital – sequence: 1 fullname: Noguchi, Yoshinori organization: Department of General Medicine, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Hasegawa, Yasuhiro organization: Department of Neurology, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Nishi, Ryoji organization: Department of Neurology, Nagoya Daini Red Cross Hospital – sequence: 1 fullname: Nakai, Noriyoshi organization: Current address: Department of Neurology, TOYOTA Memorial Hospital |
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| Copyright | 2013 The Japan Stroke Society |
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| DOI | 10.3995/jstroke.35.79 |
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| References | 2)藤岡祐介，真野智生，荒木 周ら：若年発症脳梗塞の臨床特徴－当院における検討－．脳卒中31: 15-22, 2009 9)Kerber KA, Brown DL, Lisabeth LD, et al: Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 37: 2484-2487, 2006 24)Nor AM, Davis J, Sen B, et al: The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol 4: 727-734, 2005 1)Oppenheim C, Stanescu R, Dormont D, et al: False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 21: 1434-1440, 2000 7)小出千秋，花沢秀行，今井昭雄ら：救急外来を受診しためまい患者－脳血管障害によるめまいの発見－．新潟市病医誌17: 1-9, 1996 15)城倉 健：脳卒中とめまい．日医師会誌134: 1485-1490, 2005 14)Tusa RJ: Dizziness. Med Clin North Am 87: 609-641, 2003 12)白倉真人，朝比奈紀彦：富士吉田市立病院におけるめまい患者の統計的観察．昭医会誌49: 101-105, 1989 19)三宅浩郷：実地臨床におけるめまい診療の実態．耳喉58: 863-871, 1986 3)須賀徳明，橋詰 淳，辻本昌史ら：急性期脳幹梗塞のMRI拡散強調画像による検出－冠状断画像の意義－(学会抄録)．臨床神経学44: 1163, 2004 13)宇野敦彦，長井美樹，坂田義治ら：市中病院耳鼻咽喉科における最近のめまい統計．日耳鼻104: 1119-1125, 2001 17)Chalela JA, Kidwell CS, Nentwich LM, et al: Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369: 293-298, 2007 11)Sloane PD, Baloh RW: Persistent dizziness in geriatric patients. J Am Geriatr Soc 37: 1031-1038, 1989 5)中森知毅，今福一郎：中枢性頭位性めまい．JOHNS 22: 228-234, 2006 10)十名洋介，内藤 泰，佐藤慎一ら：救急外来におけるめまい症例の検討．Equilibrium Res 70: 30-36, 2011 23)Kidwell CS, Starkman S, Eckstein M, et al: Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 31: 71-76, 2000 20)松永 喬：めまい患者のチーム診療の体制化．耳喉58: 883-889, 1986 21)小柏靖直，武井泰彦，松田剛明ら：当院におけるめまい救急診療の現状と，効率的なめまい診療システムについて．日耳鼻112: 697-704, 2009 18)Edlow JA, Newman-Toker DE, Savitz SI: Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7: 951-964, 2008 4)小山 徹，上條剛志，高田充規子ら：救急医療におけるめまいに対する初期診断－危険な責任病変に対する診断の的確性に関する検討－．日救急医会誌16: 1-8, 2005 8)中村 正：救急医療とめまい・ふらつき．JOHNS 18: 1259-1264, 2002 25)山田晋一郎，仁紫了爾，川畑和也ら：Wallenberg症候群の臨床特徴－救急外来初期診断の検討－(学会抄録)．臨床神経学50: 739, 2010 6)Alvord LS, Herr RD: ENG in the emergency room: subtest results in acutely dizzy patients. J Am Acad Audiol 5: 384-389, 1994 22)Kothari RU, Pancioli A, Liu T, et al: Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med 33: 373-378, 1999 16)小林 謙，五十嵐岳史：耳鼻咽喉科診療所におけるめまい診療の実態．Equilibrium Res 67: 108-114, 2008 |
| References_xml | – reference: 23)Kidwell CS, Starkman S, Eckstein M, et al: Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 31: 71-76, 2000 – reference: 21)小柏靖直，武井泰彦，松田剛明ら：当院におけるめまい救急診療の現状と，効率的なめまい診療システムについて．日耳鼻112: 697-704, 2009 – reference: 8)中村 正：救急医療とめまい・ふらつき．JOHNS 18: 1259-1264, 2002 – reference: 18)Edlow JA, Newman-Toker DE, Savitz SI: Diagnosis and initial management of cerebellar infarction. Lancet Neurol 7: 951-964, 2008 – reference: 1)Oppenheim C, Stanescu R, Dormont D, et al: False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol 21: 1434-1440, 2000 – reference: 22)Kothari RU, Pancioli A, Liu T, et al: Cincinnati Prehospital Stroke Scale: reproducibility and validity. Ann Emerg Med 33: 373-378, 1999 – reference: 13)宇野敦彦，長井美樹，坂田義治ら：市中病院耳鼻咽喉科における最近のめまい統計．日耳鼻104: 1119-1125, 2001 – reference: 5)中森知毅，今福一郎：中枢性頭位性めまい．JOHNS 22: 228-234, 2006 – reference: 19)三宅浩郷：実地臨床におけるめまい診療の実態．耳喉58: 863-871, 1986 – reference: 11)Sloane PD, Baloh RW: Persistent dizziness in geriatric patients. J Am Geriatr Soc 37: 1031-1038, 1989 – reference: 4)小山 徹，上條剛志，高田充規子ら：救急医療におけるめまいに対する初期診断－危険な責任病変に対する診断の的確性に関する検討－．日救急医会誌16: 1-8, 2005 – reference: 25)山田晋一郎，仁紫了爾，川畑和也ら：Wallenberg症候群の臨床特徴－救急外来初期診断の検討－(学会抄録)．臨床神経学50: 739, 2010 – reference: 6)Alvord LS, Herr RD: ENG in the emergency room: subtest results in acutely dizzy patients. J Am Acad Audiol 5: 384-389, 1994 – reference: 16)小林 謙，五十嵐岳史：耳鼻咽喉科診療所におけるめまい診療の実態．Equilibrium Res 67: 108-114, 2008 – reference: 12)白倉真人，朝比奈紀彦：富士吉田市立病院におけるめまい患者の統計的観察．昭医会誌49: 101-105, 1989 – reference: 2)藤岡祐介，真野智生，荒木 周ら：若年発症脳梗塞の臨床特徴－当院における検討－．脳卒中31: 15-22, 2009 – reference: 15)城倉 健：脳卒中とめまい．日医師会誌134: 1485-1490, 2005 – reference: 20)松永 喬：めまい患者のチーム診療の体制化．耳喉58: 883-889, 1986 – reference: 14)Tusa RJ: Dizziness. Med Clin North Am 87: 609-641, 2003 – reference: 17)Chalela JA, Kidwell CS, Nentwich LM, et al: Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 369: 293-298, 2007 – reference: 24)Nor AM, Davis J, Sen B, et al: The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol 4: 727-734, 2005 – reference: 10)十名洋介，内藤 泰，佐藤慎一ら：救急外来におけるめまい症例の検討．Equilibrium Res 70: 30-36, 2011 – reference: 3)須賀徳明，橋詰 淳，辻本昌史ら：急性期脳幹梗塞のMRI拡散強調画像による検出－冠状断画像の意義－(学会抄録)．臨床神経学44: 1163, 2004 – reference: 7)小出千秋，花沢秀行，今井昭雄ら：救急外来を受診しためまい患者－脳血管障害によるめまいの発見－．新潟市病医誌17: 1-9, 1996 – reference: 9)Kerber KA, Brown DL, Lisabeth LD, et al: Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 37: 2484-2487, 2006 |
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| Title | Prospective study trial to increase the diagnostic accuracy of stroke among patients presenting to the emergency room with acute dizziness, vertigo and floating sensation -efficacy of "disequilibrium template" |
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