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Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag

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Abstract

Objective

We aimed to determine the incidence of all vestibular symptoms in a large interdisciplinary tertiary emergency department (ED) and to assess stroke prevalence, and frequency of other life-threatening aetiologies.

Methods

In this 1-year retrospective study, we manually screened all medical records of 23,608 ED visits for descriptions of vestibular symptoms. Symptoms were classified according to the International Classification of Vestibular Disorders of the Bárány Society. We evaluated all patients older than 16 years in whom vestibular symptoms were the main or accompanying complaint. We extracted clinical, radiological, and laboratory findings as well as aetiologies from medical records.

Results

We identified a total of 2596 visits by 2464 patients (11% of ED visits) who reported at least one vestibular symptom. In 1677/2596 visits (64.6%), vestibular symptoms were the main reason for the ED consultation. Vestibular symptoms were classified as dizziness (43.8%), vertigo (33.9%), postural symptoms (6.5%), or more than one symptom (15.8%). In 324/2596 visits (12.5%), cerebrovascular events were the aetiology of vestibular symptoms, and in 355/2596 visits (13.7%), no diagnosis could be established. In 23.8% of visits with vestibular symptoms as the main complaint, the underlying condition was life-threatening.

Conclusion

Frequency and impact of vestibular symptoms in patients visiting the ED were higher than previously reported, and life-threatening aetiologies such as strokes are common. Therefore, awareness among physicians regarding the importance of vestibular symptoms has to be improved.

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Abbreviations

CT:

Computed tomography

ED:

Emergency department

ENT:

Ear, nose, and throat

MRI:

Magnetic resonance imaging

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Acknowledgements

We thank the team of the Neuro-Clinical Trials Unit for their support with regulatory submissions and Ms. Susan Kaplan for assistance with the preparation of the manuscript.

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Author notes

  1. Joint leading authors: Roger Kalla and Urs Fischer.

Authors and Affiliations

  1. Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland

    Martina Goeldlin, Janika Gaschen, Christoph Kammer, Corrado A. Bernasconi, Claudio L. Bassetti, Roger Kalla & Urs Fischer

  2. University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Martina Goeldlin

  3. Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Lukas Comolli & Georgios Mantokoudis

  4. Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Aristomenis K. Exadaktylos & Beat Lehmann

  5. Division of Internal Medicine and Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland

    Rainer Spiegel

Authors
  1. Martina Goeldlin
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  2. Janika Gaschen
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  3. Christoph Kammer
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  5. Corrado A. Bernasconi
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  6. Rainer Spiegel
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  7. Claudio L. Bassetti
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  8. Aristomenis K. Exadaktylos
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  9. Beat Lehmann
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  10. Georgios Mantokoudis
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  11. Roger Kalla
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  12. Urs Fischer
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Corresponding author

Correspondence to Urs Fischer.

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Conflicts of interest

This was an investigator-initiated study with no external sponsorship. M. Goeldlin’s work is supported by a “Young Talents in Clinical Research” Grant by the SAMW/Bangerter-Rhyner foundation (Grant YTCR_13/18). Dr. Bernasconi has received consulting fees from Roche, Santhera, AC Immune and PresSura Neuro. Dr. Kalla and Dr. Mantokoudis were supported by the Swiss National Science Foundation (Grant #320030_173081). Dr. Fischer is a consultant for Medtronic, Stryker and CSL Behring. He is the Co-PI of the SWIFT DIRECT trial (supported by Medtronic). He receives research grants from the Swiss Heart Foundation and the Swiss National Science Foundation.

Ethical approval

 The study was approved by the local ethics committee and was conducted in accordance with the Declaration of Helsinki. Given the retrospective nature of the study, informed consent was provided through a hospital-wide general consent. However, patients who withdrew consent for evaluation of their medical data had to be excluded in accordance with legal requirements.

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Goeldlin, M., Gaschen, J., Kammer, C. et al. Frequency, aetiology, and impact of vestibular symptoms in the emergency department: a neglected red flag. J Neurol 266, 3076–3086 (2019). https://doi.org/10.1007/s00415-019-09525-4

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  • DOI: https://doi.org/10.1007/s00415-019-09525-4

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