Improving benign paroxysmal positional vertigo management in the emergency department: A longitudinal study post-GRACE-3.

Abstract

Background: Vertigo is a priority for training and decision support in emergency departments (ED). Benign paroxysmal positional vertigo (BPPV), though manageable at bedside, remains frequently underdiagnosed and undertreated. This study assessed the effectiveness of a two-tiered educational intervention on posterior and horizontal BPPV management in the ED setting.

Methods: Longitudinal program evaluation study conducted over a year in a French ED, following GRACE-3 guidelines, involving patients with triggered episodic vestibular syndrome or brief vertigo without nystagmus. Two 6-month periods were compared: before (control cohort) and after (intervention cohort) an educational intervention of standardized training and an online decision support tool. The primary outcome was the prevalence of evidence-based BPPV diagnoses.

Results: Of the 382 patients included, 166 were in the control cohort (43.5%) and 216 were in the intervention cohort (56.5%). The intervention cohort had a higher rate of evidence-based BPPV diagnoses compared to the control cohort (38.0% vs. 16.9%), with an effect size of 21.1 (95% confidence interval [CI] 11.5-29.6, p < 0.0001). Canalith repositioning maneuvers were performed more frequently in the intervention cohort (90.2% vs. 57.7%), with an effect size of 33.1 (95% CI 13.2-53.1). Posttreatment tests showed a nonsignificant difference of 79.5% of intervention cohort patients testing negative versus 75.0% in the control cohort. ED length of stay was shorter in the intervention cohort (137 min vs. 247 min), with an effect size of -109.5 (95% CI -154.0 to -65.0). ED revisits within 1 month were similar (2.3% vs. 1.2%). During the intervention period, clinicians' satisfaction was correlated with the effectiveness of their clinical management.

Conclusions: A standardized educational intervention demonstrated enhancing BPPV screening and improved evidence-based diagnosis, showing promise of more efficient treatment in the ED. Further multicenter studies are warranted to evaluate impacts on patient-reported outcomes and resource optimization.