Acil servis hekimlerinin vertigoya yaklaşımlarının ve standing algoritmasını kullanımlarının değerlendirilmesi

Yıl 2025, Cilt: 8 Sayı: 4, 601 - 605, 30.07.2025

Nihal Ertürk , Edip Varan , Yüce İslamoğlu , Huriye Yürük Mısırlıoğlu

https://doi.org/10.32322/jhsm.1685033

Öz

AMAÇLAR: Acil servise başvuru oranı yüksek olan vertigo konusunda hekimlerin hastalara ilk yaklaşımlarını ve bilgilerini araştırmak; yeni kılavuzlarda önerilen algoritmaların kullanımı konusunda farkındalık yaratmak; doğru ve hızlı tanı koymak; tanı aşamasında hastaların gereksiz yere muayene edilmesini önlemek; tedavi kalitesini ve hızını artırmak en önemli hedeflerimizdi.
YÖNTEMLER: Türkiye'deki tüm illerde yetişkin acil servislerinde çalışan hekimlere çevrimiçi anket gönderildi. Anket beş bölümden ve 34 sorudan oluşuyordu. Demografik bilgileri içeren 4 soru, hastaya genel yaklaşımı sorgulayan 8 soru, vertigo ile ilgili kavramları sorgulayan 4 soru, genel bilgileri sorgulayan 9 soru ve son bölümde algoritmalar ve diğer bilgileri sorgulayan 9 soru vardı.
BULGULAR: Türkiye'deki çeşitli hastanelerin acil servislerinde çalışan 171 hekim kendi rızalarıyla ankete katıldı. Katılımcıların medyan yaşı 34 olarak hesaplandı. Vertigolu hastaların yaş aralığı sorulduğunda %43,3'ü 40-50 yaş aralığında olduğunu, %93,6'sı ise kadın hastaların daha fazla başvurduğunu belirtti. En çok istenen test %79 ile EKG oldu. Hastaların %32,3'ünün STANDING algoritmasını bildiğini, %19,2'sinin ise kullandığını belirttiği görüldü. Vertigolu hastalarda HIT testinin kullanılma oranı %38,4 olarak belirlendi. Hekimin vertigolu hastalara ilişkin deneyiminin mevcut yanıt oranı artarken, akademik düzey ile doğru yanıt oranı arasında anlamlı bir fark bulunmadı.
SONUÇ: Acil hekimleri, vertigolu hastalar için yatak başı fizik muayene teknikleri konusunda daha fazla eğitim almalı ve STANDING algoritması konusunda daha fazla pratik yapmalıdır.

Anahtar Kelimeler

vertigo , acil servis , HİT , STANDİNG

Evaluation of emergency service physicians' approaches to vertigo and their use of the standing algorithm

Öz

Aims: The most important goal of the study was to investigate the initial approaches of physicians to patients and their level of knowledge about vertigo, which has a very high rate of emergency department visits; and to make accurate and rapid diagnosis by creating awareness about the use of the STANDING algorithm recommended in the new guidelines.
Methods: An online survey was sent to physicians working in adult emergency departments in all provinces in Turkiye. The survey consisted of five sections and 34 questions. There were 4 questions containing demographic data, 8 questions asking about the general approach to the patient, 4 questions about concepts related to vertigo, 9 questions about general knowledge, and the last section included 9 questions asking about algorithms and other knowledge.
Results: 171 physicians working in emergency departments of various hospitals in Turkiye participated in the survey with their own consent. The median age of the participants was calculated as 34. When asked about the age range of patients with vertigo, 43.3% stated that they were between 40-50, and 93.6% stated that female patients applied more. The most requested test was ECG with 79%. It was observed that 32.3% of physicians stated that they knew the STANDING algorithm and 19.2% stated that they used it. The rate of using the head impulse test (HIT) test in patients with vertigo was determined as 38.4%. While the current response rate of the physician’s experience with vertigo increased, no significant difference was found between the academic level and the correct response rate.
Conclusion: Emergency physicians should receive more training in bedside physical examination techniques for patients with vertigo and should have more practice with STANDING algorithm.

Anahtar Kelimeler

Vertigo , emergency department , HIT , STANDING

Kaynakça

• Özhasenekler A, Eroğlu S, Aslaner M, et al. Tintinalli Acil Tıp: Kapsamlı Çalışma Kılavuzu, 9. Baskı. 2021.
• Palmeri R, Kumar A. Benign paroxysmal positional vertigo. 2017.
• Vanni S, Vannucchi P, Pecci R, et al. Consensus paper on the management of acute isolated vertigo in the emergency department. Int Emergenc Med. 2024;19(5):1181-1202.
• Edlow JA, Carpenter C, Akhter M, et al. Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): acute dizziness and vertigo in the emergency department. Acad Emerg Med. 2023;30(5):442-486. doi:10.1111/acem.14728
• Newman-Toker DE. Missed stroke in acute vertigo and dizziness: it is time for action, not debate. Ann Neurol. 2016;79(1):27-31. doi:10.1002/ana.24532
• Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. Acad Emerg Med. 2008; 15(8):744-750. doi:10.1111/j.1553-2712.2008.00189.x
• Labuguen RH. Initial evaluation of vertigo. Am Fam Physician. 2016; 73(2):244-251.
• Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82. doi:10.1016/B978-0-444-63437-5.00005-4
• Salerno A, Strambo D, Nannoni S, Dunet V, Michel P. Patterns of ischemic posterior circulation strokes: a clinical, anatomical, and radiological review. Int J Stroke. 2022;17(7):714-722. doi:10.1177/17474930211046758
• Ohle R, Montpellier RA, Marchadier V, et al. Can emergency physicians accurately rule out a central cause of vertigo using the HINTS examination? A systematic review and meta-analysis. Acad Emerg Med. 2020;27(9):887-896. doi:10.1111/acem.13960
• Savitz SI, Caplan LR, Edlow JA. Pitfalls in the diagnosis of cerebellar infarction. Acad Emerg Med. 2007;14(1):63-68. doi:10.1197/j.aem.2006. 06.060
• Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-3510. doi:10.1161/STROKEAHA.109.551234
• Vanni S, Pecci R, Edlow JA, et al. Differential diagnosis of vertigo in the emergency department: a prospective validation study of the STANDING algorithm. Front Neurol. 2017;8:590. doi:10.3389/fneur. 2017.00590
• Newman-Toker DE, Edlow JA. TiTrATE: a novel, evidence-based approach to diagnosing acute dizziness and vertigo. Neurol Clin. 2015; 33(3):577-599. doi:10.1016/j.ncl.2015.04.011
• Newman-Toker DE, Kerber KA, Hsieh YH, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013;20(10):986-996. doi:10.1111/acem. 12223
• Kuroda R, Nakada T, Ojima T, et al. The TriAGe+ score for vertigo or dizziness: a diagnostic model for stroke in the emergency department. J Stroke Cerebrovasc Dis. 2017;26(5):1144-1153. doi:10.1016/j.jstrokecerebrovasdis.2017.01.009
• Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504-3510. doi:10.1161/STROKEAHA.109.551234
• Dmitriew C, Regis A, Bodunde O, et al. Diagnostic accuracy of the HINTS exam in an emergency department: a retrospective chart review. Acad Emerg Med. 2021;28(4):387-393. doi:10.1111/acem.14171
• Domínguez Durán E, Mármol Szombathy I, Palmero Olmo E, et al. Epidemiology of balance disorders in primary care. Acta Otorrinolaringologica Esp (Engl Ed). 2021;72(1):11-20. doi:10.1016/j.otorri.2019.12.006
• Muncie HL, Sirmans SM, James E. Dizziness: approach to evaluation and management. Am Fam Physician. 2017;95(3):154-162.
• Hoffman RM, Einstadter D, Kroenke K. Evaluating dizziness. Am J Med. 1999;107(5):468-478. doi:10.1016/s0002-9343(99)00260-0
• Bressi F, Vella P, Casale M, et al. Vestibular rehabilitation in benign paroxysmal positional vertigo: reality or fiction? Int J Immunopathol Pharmacol. 2017;30(2):113-122. doi:10.1177/0394632017709917
• Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183(9):E571-E592. doi:10.1503/cmaj.100174