title: Nystagmus assessments documented by emergency physicians in acute dizziness presentations: a target for decision support?
abstract: OBJECTIVE
  Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. The authors sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be an important 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 study. 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 185 of 887 (20.9%) visits. When nystagmus was present, no further characteristics were recorded in 48 of the 185 visits (26%). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 10 of the 185 (5.4%) visits. The nystagmus description conflicted with the EP diagnosis in 113 (80.7%) of the 140 visits that received a peripheral vestibular diagnosis.
  
  
  CONCLUSIONS
  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 when a peripheral vestibular diagnosis is rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations.
authors.affiliation: Department of Neurology, University of Michigan Health System, Ann Arbor, USA. kakerber@umich.edu
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Kerber
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
authors.forename: Thomas
authors.initials: T
authors.lastname: McLaughlin
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Hall
authors.forename: Jane
authors.initials: J
authors.lastname: Forman
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
authors.forename: David E
authors.initials: DE
authors.lastname: Newman-Toker
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo; D003661:Decision Support Techniques; D004244:Dizziness / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic; D009760:Nystagmus, Physiologic; D014717:Vertigo / Q000150:complications / Q000175:diagnosis*; D020338:Vestibular Neuronitis / Q000150:complications / Q000175:diagnosis*