Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Sep;40(8):e830-e838.
doi: 10.1097/MAO.0000000000002338.

An Educational Intervention for Acute Dizziness Care: A Randomized, Vignette-based Study

William J Meurer  1   2   3 , Patricia Johnson  2 , Devin Brown  2   3 , Alexander Tsodikov  4 , Brigid Rowell  2 , Angela Fagerlin  5   6 , Steven A Telian  7 , Laura Damschroder  8 , Lawrence C An  9   10 , Lewis B Morgenstern  1   2   3 , Kevin A Kerber  2   3
Affiliations
Randomized Controlled Trial

An Educational Intervention for Acute Dizziness Care: A Randomized, Vignette-based Study

William J Meurer et al. Otol Neurotol. 2019 Sep.

Abstract

Importance: Benign paroxysmal positional vertigo (BPPV) is a common cause of acute dizziness. Strong evidence exists for diagnosing BPPV using the Dix-Hallpike Test (DHT) and treating it with the canalith repositioning maneuver (CRM). Despite this, both are infrequently used in the emergency department (ED).

Objective: As an early method to evaluate a BPPV-focused educational intervention, we evaluated whether an educational intervention improved ED provider performance on hypothetical stroke and BPPV cases delivered by vignette.

Design: A randomized, controlled, educational intervention study in ED physicians. The intervention aimed to promote the appropriate use of the DHT and CRM. A BPPV vignette, a stroke-dizziness (safety) vignette, and vignette scoring schemes (higher scores indicating more optimal care) used previously established vignette methodology.

Setting: We recruited participants at the exhibitor hall of an emergency medicine annual meeting.

Participants: We recruited 48 emergency physicians. All were board certified or residency trained and board eligible. All were engaged in the active practice of emergency medicine. None were trainees.

Interventions: Intervention group: a narrated, educational presentation by computer followed by the clinical vignettes.

Control group: Received no educational intervention and completed the clinical vignettes-intended to mirror current clinician practice.

Main outcome measure: Primary endpoint: total score (out of 200 points) on a vignette-based scoring instrument assessing the performance of history, physical, and diagnostic testing on hypothetical stroke and BPPV cases.

Results: The efficacy threshold was crossed at the interim analysis. The intervention group had higher performance scores compared with controls (113.2 versus 68.6, p < 0.00001). BPPV and safety subscores were both significantly higher in the intervention group. Sixty-two percent of the intervention group planned to use the DHT versus 29% of controls. After the vignette described characteristic BPPV nystagmus, 100% of the intervention group planned to use the CRM versus 17% of controls.

Conclusions and relevance: The educational intervention increased provider performance in dizziness vignettes, including more frequent appropriate use of the DHT/CRM. These findings indicate the intervention positively influenced planned behavior. Future work is needed to implement and evaluate this intervention in clinical practice.

PubMed Disclaimer

Conflict of interest statement

Potential Conflicts of Interest

No authors have any conflicts of interest to report.

Figures

Figure 1:
Figure 1:
Participant reported future approach to patients with dizziness. Participants were asked to indicate how frequently they anticipate doing each specified activity in future dizziness visits when there is not a clear cause after the history and general examination.
Figure 2:
Figure 2:
Participant level of agreement with factors important to “ruling-in” a diagnosis of Benign Paroxysmal Positional Vertigo, and optimism regarding postional testing and treatment
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kerber KA, Meurer WJ, West BT and Mark Fendrick A, Dizziness presentations in US emergency departments, 1995–2004, Academic Emergency Medicine, 2008, 15(8):744–750. - PubMed
    1. Nedzelski J, Barber H and McIlmoyl L, Diagnoses in a dizziness unit, The Journal of otolaryngology, 1986, 15(2):101–104. - PubMed
    1. Kerber KA, Brown DL, Lisabeth LD, Smith MA and Morgenstern LB, Stroke among patients with dizziness, vertigo, and imbalance in the emergency department, Stroke, 2006, 37(10):2484–2487. - PMC - PubMed
    1. Kerber KA, Meurer WJ, Brown DL, Burke JF, Hofer TP, Tsodikov A, Hoeffner EG, et al., Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study, Neurology, 2015, 85(21):1869–1878. - PMC - PubMed
    1. Kim J-S and Zee DS, Benign paroxysmal positional vertigo, New England Journal of Medicine, 2014, 370(12):1138–1147. - PubMed

Publication types