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This month’s update is from the Research in Emergency Care, Avon Collaborative Hub (REACH) team based in Bristol, UK. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
The papers are ranked as follows:
Worth a peek—interesting, but not yet ready for prime time.
Head turner—new concepts.
Game changer—this paper could/should change practice.
Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: a systematic review and meta-analysis for the guidelines for reasonable and appropriate care in the emergency department by Shah et al.
Rating: head turner
Acute vertigo or dizziness poses a clinical conundrum for the emergency physician in differentiating benign peripheral disorders from potentially significant central causes. Physicians often rely on neuroimaging to aid diagnosis.
This systematic review and meta-analysis sought to assess the diagnostic accuracy of neuroimaging for identifying central causes. 1 The authors searched the literature from 2000 to 2021 and found 12 studies which assessed the ability of a diagnostic test to differentiate stroke and other central causes from peripheral disorders. The modalities included non-contrast CT (n=771), computer tomography angiography (CTA) (n=153), MRI (n=943), magnetic resonance angiography (MRA) (n=24) and ultrasound (US) (n=258).
The pooled sensitivity for central causes of non-contrast CT was 28.5% (giving rise to moderate certainty) and just 14.3% for CTA. Sensitivities for MRI and MRA were higher at 79.8% (high certainty) and 60%, respectively. US sensitivities were reported between 30% and 53.6%. Specificity of neuroimaging was significantly higher, with a negligible number of false positives.
Limitations to this review include the small number of studies for less frequently used modalities, such as CT and MR angiography.
Neuroimaging should not be relied on to rule out central causes in patients with acute vertigo or dizziness in the ED.
Awareness with paralysis among critically ill emergency department patients: a prospective cohort study by Fuller et al.
Rating: head turner
Twitter @hirstposition, @GrossiIrene
Contributors RH, HC, IG, CH, ATM-S and ES surveyed the literature and produced the research summaries. RH was responsible for organisation, editing, revisions and submission of this document.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.