Bridging the gap: improving diagnosis of acute vertigo from referring clinicians to neuro- otology

<h3>Introduction</h3> Acute vertigo is often misdiagnosed, especially in the acute setting. Here, we analyse and compare the assessment and diagnosis of referring clinicians with neuro-otology physicians. <h3>Methods</h3> This is a retrospective case-note analysis of patients presenting with acute vertigo, to the emergency department (ED), who were subsequently referred to a neuro-otology clinic at the National Hospital for Neurology and Neurosurgery. <h3>Results</h3> Of the 70 patients included in the study, 57% were female, The mean age at presentation was 57 ± 16.5 years. In the neuro-otology specialist setting, nystagmus was documented in 99% patients, VOR in 92% and the Dix-Hallpike in 69% but far less frequently in the ED setting where they were performed in 68%, 28% and 13% respectively. Acute vascular diagnoses frequently had gaze-evoked (60%), vertical (50%), or bidirectional (40%) nystagmus, whilst spontaneous nystagmus (54%) was seen most commonly in peripheral vestibular disease. 50% of patients who had an acute vascular diagnosis by the specialists presented with a fall. Patients with abnormal ECGs had 4.5 times higher odds of vascular-related vertigo. Referring clinician diagnoses were changed by specialists in 77% of cases. <h3>Discussion</h3> Our findings highlight the need for better diagnostic tools for acute vertigo aimed at the non-specialist.