Background: Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision making support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. We sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be a target in decision support efforts.
Methods: Medical records from ED visits for dizziness were captured as part of a surveillance study embedded within an ongoing population-based cohort. Visits with documentation of a nystagmus assessment were reviewed and coded for presence or absence of nystagmus, ability to draw a meaningful inference from the description, and coherence with the final EP diagnosis when a peripheral vestibular diagnosis was made.
Results: Of 1,091 visits for dizziness, 887 (81.3%) documented a nystagmus assessment. Nystagmus was present in 20.9% (185 of 887) of visits. When nystagmus was present, no further characteristics were recorded in 26% (48 of 185). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 5.4% (10 of 185) of the visits. The nystagmus description conflicted with the EP diagnosis in 77.9% (81 of 104) visits that received a diagnosis of vestibular neuritis and 88.9% (32 of 36) visits that received a diagnosis of benign positional vertigo.
Conclusion: Nystagmus assessments are frequently documented in acute dizziness presentations but details do not generally enable a meaningful inference. Recorded descriptions usually conflict with the diagnosis rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations.
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