“BPPV in the Emergency Department: An observational study of an Australian regional hospital’s acute clinical practice

Ms Prue Neely1, Dr  Hemal Patel1, Dr  Tom Wellings2

1Central Coast Local Health District, Wyong , Australia, 2John Hunter Hospital, New Lambton Heights , Australia

Objective: To analyse adherence to evidence based practice in the diagnosis and treatment of Benign Paroxysmal Positional Vertigo (BPPV) in a regional emergency department.

Design: Retrospective observational population study.

Setting: Wyong Emergency Department, Central Coast Local Health District, New South Wales, Australia.

Subjects and Method: Medical records of patients with an Emergency Department diagnosis of BPPV (n=101) between 2017-2018 were included for auditing. Adherence to. Bhattacharyya et al 2017 clinical practice guidelines for BPPV statements 1a, 3a, 4a and 6 were reviewed as primary outcomes using a de-identified binary data excel tool. These outcomes were compared to available data from metropolitan tertiary emergency departments both in Australia and the United States.

Results: General compliance to best practice standards was low. Of patients diagnosed with BPPV in the emergency department only 45% [95% CI (0.35-0.54)] were diagnosed with the recommended Hallpike-Dix positional test. Of those patients who did receive diagnosis via the Hallpike-Dix test only 41% [95% CI (0.28-0.56)] went on to receive gold standard recommended treatment of a Canalith Repositioning Manoeuvre/Technique. In regards to the recommendations against practice, 36% [95% CI (0.28-0.46)] had neuroimaging performed in the emergency department.

Conclusion: Adherence to best practice in the diagnosis and management of BPPV was low in Wyong emergency department. Although low, Wyong ED appeared to perform better in compliance to the clinical guidelines to its metropolitan Australian peer. There is opportunity to improve the efficiency and effectiveness in the management of acute peripheral dizziness in emergency departments.

Jeon, E.J., Lee, D,H, Park, J.M., Oh, J.H. & Seo, J.H. (2019). The efficacy of a modified Dix-Hallpike test with a pillow under shoulders. J Vestib Res.29(4):197-203. doi: 10.3233/VES-190666. PMID: 31256096.
Vision Eye Institute. (2021) Is laser eye surgery safe? Copyright 2021 Vision Eye Institute. All rights reserved. Retrieved from : https://visioneyeinstitute.com.au/eyematters/laser-eye-surgery-safe/


Prue Neely B.Phty, MHM (Hons)

Prue Neely is a Senior Emergency Physiotherapist at Central Coast Local Health District. Prue graduated from Charles Sturt University with a Bachelor of Physiotherapy in 2009. She has worked both locally and internationally in public and private health sectors. She first became interested in vestibular physiotherapy after working at Guys Hospital in London. Since then she has achieved advanced competency in her practice. Prue moved into emergency medicine in 2014 and has been practicing in a primary contact role between Gosford and Wyong Hospitals on the New South Wales Central Coast.

She was selected as a Physiotherapist for the XXI Commonwealth games for the coverage of Boxing, Squash and Badminton. In 2020 Prue presented internationally to the Myanmar Physiotherapy Association on the Role of Physiotherapist within the emergency department as well as graduating with excellence from a Master of Health Management from UNSW.

Prue is passionate about translational research and evidence-based practice in her interest area of acute management of dizziness as well as strategic planning and service development.

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