title: Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms.
abstract: BACKGROUND
  We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients.
  
  
  METHODS
  We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule.
  
  
  RESULTS
  The response rate was 68% (366/535). Respondents' median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests' bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.
  
  
  CONCLUSIONS
  EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.
authors.affiliation: The Permanente Medical Group ; Kaiser Permanente Fremont Medical Center, Department of Emergency Medicine, Fremont, California.
authors.forename: Mamata V
authors.initials: MV
authors.lastname: Kene
authors.affiliation: The Permanente Medical Group ; Kaiser Permanente San Rafael Medical Center, Department of Emergency Medicine, San Rafael, California ; Kaiser Permanente Northern California, Division of Research, Oakland, California.
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Ballard
authors.affiliation: The Permanente Medical Group ; Kaiser Permanente Northern California, Division of Research, Oakland, California ; Kaiser Permanente Roseville Medical Center, Department of Emergency Medicine, Roseville, California.
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, California.
authors.forename: Adina S
authors.initials: AS
authors.lastname: Rauchwerger
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, California.
authors.forename: Hilary R
authors.initials: HR
authors.lastname: Iskin
authors.affiliation: University of California, San Francisco, Department of Neurology, San Francisco, California.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
mesh_terms: D000219:Adams-Stokes Syndrome / Q000150:complications* / Q000175:diagnosis; D001291:Attitude of Health Personnel; D002140:California; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004244:Dizziness / Q000209:etiology*; D004635:Emergency Medicine / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires