Patients with acute TBI admitted to our local Major Trauma Ward (MTW) were screened by therapists (SW, KC, and NM) and patients with vestibular symptoms and/or signs were referred to BMS (who provides an acute neurological service to the trauma ward). The data represent an audit of TBI patients screened by the therapists in office hours, hence, not all trauma ward cases were included (e.g., those with a brief weekend admission). All patients had brain imaging (usually CT scanning) and these scans were reviewed by a neuro-radiologist.
Study setting and participants
All adult Major Trauma Ward admissions screened by the therapists between June 2014 and May 2015 were included. A neuro-otological referral was made if patients reported vestibular symptoms assessed via a 2-minute screening questionnaire. Patients were also referred if they displayed signs of postural/gait instability irrespective of their symptoms. Patient data were obtained as standard of care for patients referred for a neuro-otology opinion. The review of these data was as approved by the local institutional research ethics process.
Clinical assessment included ophthalmoscopy and otoscopy, eye movements (cover test, gaze testing, saccades, smooth pursuit, vestibular ocular reflex testing via the head impulse test), Hallpike manoeuvre and gait assessment [Romberg test (20 s), tandem walking and tandem stance]. Where possible, clinical signs were recorded via laboratory testing (e.g., video or electro-oculography, rotational chair and otolith testing).
Outcomes and statistical analysis
The following were recorded: (1) demographics, (2) presenting symptoms, (3) examination findings, and (4) clinical diagnoses. Data were analyzed using SPSS 22.0 (IBM, New York, USA). The frequencies of patients’ symptoms, signs, and final diagnoses, were reported.