Literature DB >> 26231272

Misdiagnosing Dizzy Patients: Common Pitfalls in Clinical Practice.

Kevin A Kerber1, David E Newman-Toker2.   

Abstract

This article highlights 5 pitfalls in the diagnosis of common vestibular disorders: (1) overreliance on dizziness symptom type to drive diagnostic inquiry; (2) underuse and misuse of timing and triggers to categorize patients; (3) underuse, misuse, and misconceptions linked to hallmark eye examination findings; (4) overweighting age, vascular risk factors, and neuroexamination to screen for stroke; and (5) overuse and overreliance on head computed tomography to rule out neurologic causes. This article discusses the evidence base describing each pitfall's frequency and likely causes, and potential alternative strategies that might be used to improve diagnostic accuracy or mitigate harms.
Copyright © 2015 Elsevier Inc. All rights reserved.

Entities:  

Keywords:  Dizziness; Management; Vertigo; Vestibular disorder

Mesh:

Year:  2015        PMID: 26231272      PMCID: PMC9023124          DOI: 10.1016/j.ncl.2015.04.009

Source DB:  PubMed          Journal:  Neurol Clin        ISSN: 0733-8619            Impact factor:   3.787


  48 in total

1.  Postural control in benign paroxysmal positional vertigo before and after recovery.

Authors:  S Di Girolamo; G Paludetti; G Briglia; A Cosenza; R Santarelli; W Di Nardo
Journal:  Acta Otolaryngol       Date:  1998-06       Impact factor: 1.494

Review 2.  Symptoms and signs of neuro-otologic disorders.

Authors:  David E Newman-Toker
Journal:  Continuum (Minneap Minn)       Date:  2012-10

3.  Value of computed tomography scans in ED dizziness visits: analysis from a nationally representative sample.

Authors:  Kevin A Kerber; Lisa Schweigler; Brady T West; A Mark Fendrick; Lewis B Morgenstern
Journal:  Am J Emerg Med       Date:  2010-01-28       Impact factor: 2.469

Review 4.  The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.

Authors:  Malcolm P Hilton; Darren K Pinder
Journal:  Cochrane Database Syst Rev       Date:  2014-12-08

5.  Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

Authors:  Edward C Jauch; Jeffrey L Saver; Harold P Adams; Askiel Bruno; J J Buddy Connors; Bart M Demaerschalk; Pooja Khatri; Paul W McMullan; Adnan I Qureshi; Kenneth Rosenfield; Phillip A Scott; Debbie R Summers; David Z Wang; Max Wintermark; Howard Yonas
Journal:  Stroke       Date:  2013-01-31       Impact factor: 7.914

6.  Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting.

Authors:  David E Newman-Toker; Lisa M Cannon; Matthew E Stofferahn; Richard E Rothman; Yu-Hsiang Hsieh; David S Zee
Journal:  Mayo Clin Proc       Date:  2007-11       Impact factor: 7.616

7.  Dizziness presentations in U.S. emergency departments, 1995-2004.

Authors:  Kevin A Kerber; William J Meurer; Brady T West; A Mark Fendrick
Journal:  Acad Emerg Med       Date:  2008-07-14       Impact factor: 3.451

8.  Disconnect between charted vestibular diagnoses and emergency department management decisions: a cross-sectional analysis from a nationally representative sample.

Authors:  David E Newman-Toker; Carlos A Camargo; Yu-Hsiang Hsieh; Andrea J Pelletier; Jonathan A Edlow
Journal:  Acad Emerg Med       Date:  2009-10       Impact factor: 3.451

9.  Unrecognized benign paroxysmal positional vertigo in elderly patients.

Authors:  J S Oghalai; S Manolidis; J L Barth; M G Stewart; H A Jenkins
Journal:  Otolaryngol Head Neck Surg       Date:  2000-05       Impact factor: 5.591

10.  The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence.

Authors:  Youn-Kyoung Do; Jin Kim; Chong Yoon Park; Myung-Hyun Chung; In Seok Moon; Hoon-Shik Yang
Journal:  Clin Exp Otorhinolaryngol       Date:  2011-09-06       Impact factor: 3.372

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  19 in total

Review 1.  Diagnostic error and neuro-ophthalmology.

Authors:  Leanne Stunkel; Nancy J Newman; Valérie Biousse
Journal:  Curr Opin Neurol       Date:  2019-02       Impact factor: 5.710

2.  Identifying, Analyzing, and Visualizing Diagnostic Paths for Patients with Nonspecific Abdominal Pain.

Authors:  Goutham Rao; Katherine Kirley; Paul Epner; Yiye Zhang; Victoria Bauer; Rema Padman; Ying Zhou; Anthony Solomonides
Journal:  Appl Clin Inform       Date:  2018-12-19       Impact factor: 2.342

3.  Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors: A case study on the role of a vestibular therapist in diagnosing dizziness.

Authors:  Dana B Thomas; David E Newman-Toker
Journal:  Diagnosis (Berl)       Date:  2016-05-31

4.  Pitfalls and Rewards for Implementing Ocular Motor Testing in Acute Vestibular Syndrome: A Pilot Project.

Authors:  Oana M Dumitrascu; Sam Torbati; Mourad Tighiouart; David E Newman-Toker; Shlee S Song
Journal:  Neurologist       Date:  2017-03       Impact factor: 1.398

5.  Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): a conceptual framework and methodological approach for unearthing misdiagnosis-related harms using big data.

Authors:  Ava L Liberman; David E Newman-Toker
Journal:  BMJ Qual Saf       Date:  2018-01-22       Impact factor: 7.035

6.  A New Diagnostic Approach to the Adult Patient with Acute Dizziness.

Authors:  Jonathan A Edlow; Kiersten L Gurley; David E Newman-Toker
Journal:  J Emerg Med       Date:  2018-02-01       Impact factor: 1.484

7.  Identification of dizzy patients who will develop an acute cerebrovascular syndrome: a descriptive study among emergency department patients.

Authors:  I Mármol-Szombathy; E Domínguez-Durán; L Calero-Ramos; S Sánchez-Gómez
Journal:  Eur Arch Otorhinolaryngol       Date:  2018-05-02       Impact factor: 2.503

Review 8.  Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls.

Authors:  Ali S Saber Tehrani; Jorge C Kattah; Kevin A Kerber; Daniel R Gold; David S Zee; Victor C Urrutia; David E Newman-Toker
Journal:  Stroke       Date:  2018-02-19       Impact factor: 7.914

9.  Early MRI-negative posterior circulation stroke presenting as acute dizziness.

Authors:  Jae-Hwan Choi; Eun Hye Oh; Min-Gyu Park; Seung Kug Baik; Han-Jin Cho; Seo Young Choi; Tae-Hong Lee; Ji Soo Kim; Kwang-Dong Choi
Journal:  J Neurol       Date:  2018-10-19       Impact factor: 4.849

Review 10.  ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: A meta-analysis.

Authors:  Alexander Andrea Tarnutzer; Seung-Han Lee; Karen A Robinson; Zheyu Wang; Jonathan A Edlow; David E Newman-Toker
Journal:  Neurology       Date:  2017-03-29       Impact factor: 9.910

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