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J Korean Soc Emerg Med > Volume 23(6); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(6): 799-810.
Effect of Emergency Department Video-nystagmography for Patients with Dizziness
Taegyun Kim, Sang Do Shin, Chang Bae Park, Young Ho Kwak, Joo Yeong Kim, Ji Yeon Jang, Won Pyo Hong, So Young Ha, Chang Woo Kang
1Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. sdshin@snu.ac.kr
2Department of Emergency Medicine, Seoul National University Bundang Hospital Seongnam, Korea.
We evaluated the effects of emergency department (ED)-based video-nystagmography (VNG) testing on consultation with other departments and length of ED stay of patients with dizziness.
A before-and-after study was performed at a tertiary ED from May 13, 2011 to May 12, 2012. Adult patients (age> or =15 years) with dizziness were enrolled, excluding patients with incomplete information. We defined the before- and after-phase according to implanting of the ED-based VNG test. The VNG test was performed by an internship physician supervised by 2nd or 3rd grade emergency medicine residents. Primary outcome was any consultation to other specialty departments and the secondary outcome was the length of stay at the ED. The adjusted odds ratios (ORs) with 95% confidence interval (95% CI) for outcomes by phase were estimated using multivariate logistic regression analysis adjusting for potential co-variates.
Of 1,485 eligible patients, 1,449 patients (male: 37.0%, mean age: 59.2+/-15.5 years) were enrolled (415 in the before-phase and 1,034 in the after-phase). The final diagnosis group was stroke (4.8%), peripheral vestibulopathy (44.9%), other specific disease (29.0%), and non-diagnostic symptom (21.4%). The consultation request was more reduced in the after-phase (38.1%) than the before-phase (52.5%). The LOS was not changed between both phases (7.4+/-7.5 hours versus 7.4+/-7.3 hours, p=0.76). The adjusted OR (95% CI) for the consultation of after-phase compared to before-phase was 0.46(0.35, 0.61), while the adjusted OR (95% CI) for LOS was 1.39(0.99, 1.95).
Implementation of ED-based VNG test significantly reduced the consultation with other specialty departments, while LOS was not affected.
Key words: Dizziness, Vertigo, Pathologic nystagmus
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