Benign paroxysmal positional vertigo in the emergency department: An observational study of an Australian regional hospital's acute clinical practice

Abstract

OBJECTIVE: To analyse adherence to evidence based practice in the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) in a regional ED. METHODS: Retrospective observational population study. Wyong Hospital's ED, Central Coast Local Health District, New South Wales, Australia. Medical records of patients with an ED diagnosis of BPPV (n = 101) between 2017 and 2018 were included for auditing. Adherence to clinical practice guidelines for BPPV(4) statements 1a, 3a, 4a and 6 were reviewed as primary outcomes using a de-identified binary data excel tool. These outcomes were compared to available data from metropolitan tertiary EDs both in Australia and the USA. RESULTS: General compliance to best practice standards was low. Of patients diagnosed with BPPV in the ED only 45% (95% CI 35-54%) were diagnosed with the recommended Hallpike-Dix positional test. Of those patients who did receive diagnosis via the Hallpike-Dix test only 41% (95% CI 28-56%) went on to receive gold standard recommended treatment of a canalith repositioning manoeuvre/technique. In regards to the recommendations against practice, 36% (95% CI 28-46%) had neuroimaging performed in the ED and 58% (95% CI 48-68%) received vestibular suppressant medication as their only treatment prior to discharge. CONCLUSION: Adherence to best practice diagnosis and management of BPPV was low in Wyong Hospital's ED. Although low, Wyong Hospital's ED appeared to perform better in compliance to the clinical guidelines to its metropolitan Australian peer. There is opportunity to improve the efficiency and effectiveness in the management of acute peripheral dizziness in EDs.