Checklist approach to vertigo: audit of current practice in a tertiary referral center

Nithya Venkataramani; Ravi Sachidananda; Rajesh Karalumangala Nagarajaiah

doi:10.18203/issn.2454-5929.ijohns20214679

Authors

Nithya Venkataramani Department of ENT, People Tree Hospital, Bangalore, India
Ravi Sachidananda Department of ENT, People Tree Hospital, Bangalore, India
Rajesh Karalumangala Nagarajaiah Department of ENT, People Tree Hospital, Bangalore, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20214679

Keywords:

Vertigo, Checklist, Diagnosis

Abstract

Background: Vertigo is a complex symptom which can be present in multiple conditions, some of which are life threatening. Diagnosing a patient with vertigo could sometimes be challenging and there is a need for a comprehensive, yet easily reproducible diagnostic model with emphasis on the red flag signs. A simple way to achieve this is a checklist. The aim of the study was to propose a diagnostic checklist for patients presenting with vertigo to an ENT clinic to aid diagnosis and prevent diagnostic errors.

Methods: A diagnostic checklist was used in all patients who presented with the symptom of vertigo, necessary tests were conducted and referrals were done when required.

Results: Out of eighty-five patients who presented with symptom of dizziness to ENT clinic, all patients received a definitive diagnosis treatment plan with the help of checklist.

Conclusions: Checklist is an effective way to ensure elaborate assessment of the patient with emphasis on the red flag signs. It is a very important tool to arrive at diagnosis and formulate treatment plan.

Metrics

Metrics Loading ...

References

Nelson JA, Viirre E. The clinical differentiation of cerebellar infarction from common vertigo syndromes. West J Emerg Med. 2009;10(4):273-7.

Staibano P, Lelli D, Tse D. A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic. J Otolaryngol Head Neck Surg. 2019;48(1):11.

Gawande A. The Checklist Manifesto- How to Get Things Right. New York, NY: Metropolitan Books; 2011.

Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(5):2-23.

Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008-15.

Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775-80.

Firth JD, Conlon CP, Cox TM, Peto TE, Peto P. Clinical decision-making. Oxford Textbook of Medicine. 6th ed. Oxford, UK: Oxford University Press; 2020: 26-30.

Sque M, Chipulu M, Gonigle D. Clinical decision making. In: Hall M, Noble A and Smith S, eds. A Foundation for Neonatal Care: a Multi-disciplinary Guide. Oxford, UK: Radcliffe; 2009: 235-251.

Williams R, Colligan L. Back to basics: checklists in aviation and healthcare. BMJ Qual Saf. 2015;24(7):428-31.

Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-9.

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-32.

Graber ML, Sorensen AV, Biswas J, Modi V, Wackett A, Johnson S, et al. Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis (Berl). 2014;1(3):223-31.

Hales B, Terblanche M, Fowler R, Sibbald W. Development of medical checklists for improved quality of patient care. Int J Qual Health Care. 2008;20(1):22-30.

Ely JW, Graber ML, Croskerry P. Checklists to reduce diagnostic errors. Acad Med. 2011;86(3):307-13.

Tan F, Bartels C, Walsh RM. Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation. Auris Nasus Larynx. 2018;45(2):248-53.

Saber TAS, Kattah JC, Mantokoudis G, Pula JH, Nair D, Blitz A, et al. Small strokes causing severe vertigo: frequency of false-negative MRIs and nonlacunar mechanisms. Neurology. 2014;83(2):169-73.

Toker DE, Moy E, Valente E, Coffey R, Hines AL. Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis (Berl). 2014;1(2):155-66.

Ribeiro BNF, Correia RS, Antunes LO, Salata TM, Rosas HB, Marchiori E. The diagnostic challenge of dizziness: computed tomography and magnetic resonance imaging findings. Radiol Bras. 2017;50(5):328-34.

Walther LE. Current diagnostic procedures for diagnosing vertigo and dizziness. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2017;16:2.

Jung I, Kim JS. Approach to dizziness in the emergency department. Clin Exp Emerg Med. 2015;2(2):75-88.

Saber TAS, Kattah JC, Kerber KA, Gold DR, Zee DS, Urrutia VC, et al. Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls. Stroke. 2018;49(3):788-95.

Kerber KA, Toker DE. Misdiagnosing Dizzy Patients: Common Pitfalls in Clinical Practice. Neurol Clin. 2015;33(3):565-75.

Baloh RW. Vertigo. Lancet. 1998;352(9143):1841-6.

Bath AP, Walsh RM, Ranalli P, Tyndel F, Bance ML, Mai R, et al. Experience from a multidisciplinary "dizzy" clinic. Am J Otol. 2000;21(1):92-7.

Trinidade A, Yung MW. Consultant-led, multidisciplinary balance clinic: process evaluation of a specialist model of care in a district general hospital. Clin Otolaryngol. 2014;39(2):95-101.

Sibbald M, Bruin AB, Merrienboer JJ. Checklists improve experts' diagnostic decisions. Med Educ. 2013;47(3):301-8.