SGEM#403: Unos, Dos, Tres – Vertigo: The GRACE-3 Guidelines

Trials extracted from the podcast by Dr. Ken Milne

• 2023GRACE-3Emergency & ResuscitationIn adult ED patients with acute dizziness under 2 weeks, a GRADE panel favored trained bedside eye-movement testing over routine CT or MRI to detect stroke
• 2021HINTS, STANDING and ABCD2 for central causes of acute vertigo in the emergency departmentEmergency & ResuscitationIn 300 emergency department patients with acute vertigo, HINTS and STANDING by trained emergency physicians identified central causes more sensitively than the ABCD2 score.
• 2020HINTSEmergency & ResuscitationIn617 adults with acute vestibular syndrome,the HINTS examination by emergency physiciansruled outstrokefar less reliably thanby neurologists.
• 2021Diagnostic Accuracy of the HINTS Exam in an Emergency DepartmentEmergency & ResuscitationIn 2,309 emergency department patients with dizziness, HINTS by emergency physicians fell outside validation criteria in 96.9% of exams, unlike specialist-performed validation studies.
• 2023GRACE-3Emergency & ResuscitationIn869 emergency department patients with acute vertigo or dizziness,a general neurologic examinationidentifiedcentral causes such as strokewith47% sensitivity and 93% specificity
• 2017STANDINGEmergency & ResuscitationIn 352 adults with acute vertigo in the emergency department, the four-step STANDING algorithm detected central causes against imaging plus 3-month follow-up.
• 2008International Survey of Emergency Physicians' Priorities for Clinical Decision RulesEmergency & ResuscitationAmong1,150 emergency physicians in four countries,a priority surveyrankedidentification of central or serious vertigo second (42%)behindinvestigation of the febrile child under 36 months (62%)