急诊科后管良性阵发性位置性眩晕Epley优先方法的早期失败预测因素
Predictors of Early Failure in an Epley-First Approach for Posterior Canal Benign Paroxysmal Positional Vertigo in the Emergency Department.
文献信息
| PMID | 42748497 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Muhammed Kamiloğlu |
| 作者单位 | Department of Emergency Medicine, Faculty of Medicine, Başkent University, Ankara, Turkey. Electronic address: mkamiloglu@baskent.edu.tr. |
| 期刊 | The Journal of emergency medicine |
| SCI 分区 | Q3 |
| IF | 1.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 良性阵发性位置性眩晕（BPPV）是急诊科（ED）头晕的常见原因，但床旁诊断和治疗手法仍未得到充分利用，常导致不必要的影像学检查和资源利用。
研究目的： 评估Epley优先方法的有效性，并确定后管BPPV患者早期治疗失败的预测因素。
方法： 在这项回顾性观察研究中，774例成年ED后管BPPV患者以Epley手法作为初始治疗策略进行管理。早期治疗成功定义为症状缓解且60分钟内无需额外干预。进行逻辑回归分析以确定治疗失败的独立预测因素。
结果： 81.8%的患者实现了早期症状缓解，而18.2%需要额外干预。治疗失败的患者年龄显著更大，症状持续时间更长（均p < 0.001）。在多变量分析中，年龄（OR：1.06，95% CI：1.04-1.08，p < 0.001）和症状持续时间（每分钟OR：1.03，95% CI：1.02-1.03，p < 0.001）被确定为失败的独立预测因素。预测模型表现出较强的区分能力（AUC：0.876）。在ED评估期间未记录到提示急性中枢神经系统疾病的新发现局灶性神经功能缺损。
结论： 对于在ED就诊且经过适当选择的后管BPPV患者，Epley优先方法与快速的早期症状控制相关。年龄和症状持续时间可能有助于早期风险分层，并支持在适当选择的患者中进行更个体化的诊断决策。
英文摘要
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness in the emergency department (ED), yet bedside diagnostic and therapeutic maneuvers remain underused, often leading to unnecessary imaging and resource utilization.
STUDY OBJECTIVES: To evaluate the effectiveness of an Epley-first approach and identify predictors of early treatment failure in patients with posterior canal BPPV.
METHODS: In this retrospective observational study, 774 adult ED patients with posterior canal BPPV were managed with the Epley maneuver as the initial treatment strategy. Early treatment success was defined as symptom resolution without the need for additional intervention within 60 min. Logistic regression analysis was performed to identify independent predictors of treatment failure.
RESULTS: Early symptom resolution was achieved in 81.8% of patients, while 18.2% required additional interventions. Patients with treatment failure were significantly older and had longer symptom duration (both p < 0.001). In multivariable analysis, age (OR: 1.06, 95% CI: 1.04-1.08, p < 0.001) and symptom duration (OR: 1.03 per minute, 95% CI: 1.02-1.03, p < 0.001) were identified as independent predictors of failure. The predictive model demonstrated strong discriminative performance (AUC: 0.876). No newly identified focal neurological deficits suggestive of an acute central neurological disorder were documented during ED evaluation.
CONCLUSIONS: The Epley-first approach was associated with rapid early symptom control in appropriately selected patients with posterior canal BPPV presenting to the ED. Age and symptom duration may facilitate early risk stratification and support more individualized diagnostic decision-making in appropriately selected patients.