BPPV诊疗中的诊断与治疗缺口：一项伦敦NHS信托机构的回顾性分析及可行性评估

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中文摘要

背景： 良性阵发性位置性眩晕（BPPV）是外周性眩晕最常见的原因，但在急诊环境中其评估和治疗仍不充分。尽管已有经过验证的床旁工具如Dix-Hallpike试验（DHT）和管石复位手法（CRM，如Epley法），诊断差异仍然很大，神经影像学被过度使用，前庭抑制剂也经常被处方。这项两部分评估描述了伦敦一家NHS信托机构中BPPV的评估和管理情况，并评估了将DHT纳入急诊科（ED）现有由AHP主导的跌倒路径的可行性。
方法： 在一家大型伦敦NHS教学医院开展了由两部分组成的评估。第1部分包括对电子患者记录的回顾性审查，以描述当前BPPV评估和管理实践的特征并识别潜在的服务缺口。第2部分是一项前瞻性可行性研究，评估将AHP主导的DHT筛查纳入急诊科就诊的≥65岁患者常规跌倒评估中的可行性。
结果： 第1部分识别出128例病例（平均年龄63.4岁；61.7%为女性）。BPPV是最常见的出院诊断，占45.3%（95% CI 37.0-53.9%），但仅有14.8%的病例记录了完整的评估和治疗（95% CI 9.7-22.0%）。43.8%的病例被处方前庭抑制剂，71.9%接受了神经影像学检查，18.8%未获得明确诊断。三个月内因头晕再入院的发生率为13.3%（95% CI 8.5-20.2%）。第2部分纳入102例患者，其中79例记录完整（平均年龄84.6岁；54%为女性）。DHT在62%的病例中完成（63/102次尝试；95% CI 52.1-70.6%）；8%的病例识别出BPPV（95% CI 4.0-14.7%），且均接受了CRM。三个月时未发生与头晕相关的再入院。
结论： 本评估识别出急性BPPV评估和管理中持续存在的缺口，包括神经影像学和前庭抑制剂的过度使用，以及经过验证的床旁工具利用不足。物理治疗主导的DHT筛查在繁忙的急诊科环境中是可行的，即使在患有多种合并症的老年人中也是如此；在这一小型可行性队列中未出现再入院是一个令人鼓舞的发现，值得在更大规模的对照队列中进一步评估。

英文摘要

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most prevalent cause of peripheral dizziness, yet it remains poorly assessed and treated in acute settings. Despite the availability of validated bedside tools such as the Dix-Hallpike test (DHT) and canal repositioning manoeuvres (CRM) such as the Epley, diagnostic variability is high, neuroimaging is overused, and vestibular suppressants are frequently prescribed. This two-part evaluation characterised BPPV assessment and management across a London NHS Trust and assessed the feasibility of incorporating DHT into an existing AHP-led falls pathway within the emergency department (ED).
METHODS: A two-part evaluation was conducted across a large London NHS teaching hospital. Part 1 comprised a retrospective review of electronic patient records to characterise current BPPV assessment and management practices and identify potential service gaps. Part 2 was a prospective feasibility study evaluating the incorporation of AHP-led DHT screening into routine falls assessments for patients aged ≥65 years presenting to the ED.
RESULTS: Part 1 identified 128 cases (mean age 63.4 years; 61.7% female). BPPV was the most common discharge diagnosis, 45.3% (95% CI 37.0-53.9%), yet full assessment and treatment were documented in only 14.8% of cases (95% CI 9.7-22.0%). Vestibular suppressants were prescribed in 43.8%, neuroimaging performed in 71.9 and 18.8% left without a definitive diagnosis. Readmission for dizziness within three months occurred in 13.3% (95% CI 8.5-20.2%). Part 2 included 102 patients, 79 with complete records (mean age 84.6 years; 54% female). DHT was completed in 62% (63/102 attempts; 95% CI 52.1-70.6%); BPPV was identified in 8% (95% CI 4.0-14.7%) and all received CRM. No dizziness-related readmissions occurred at three months.
CONCLUSION: This evaluation identifies consistent gaps in acute BPPV assessment and management, including overuse of neuroimaging and vestibular suppressants alongside underutilisation of validated bedside tools. Physiotherapy led DHT screening is feasible in a busy ED setting, even in older adults with multiple comorbidities, and the absence of readmissions in this small feasibility cohort is an encouraging finding that warrants evaluation in a larger, controlled cohort.