단독 어지럼증. 입원시킬 것인가? 퇴원시킬 것인가? (Isolated Dizziness. Admission? or Discharge?)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 19권 / 4호 / 421 ~ 427페이지
· 저자명 : 이수훈, 조한진, 최한성, 홍훈표, 김신철, 고영관

초록

Purpose: Dizziness is a common chief complaint in
patients presenting at emergency deparments. As central
dizziness can be life-threatening, it is important to differentiate
central from peripheral dizziness. VBI (vertebrobasilar
insufficiency) or PICA (posterior inferior cerebellar artery)
infarction can present as only isolated dizziness without
other neurologic symptoms, thus mimicking peripheral
dizziness. It is difficult to differentiate from isolated dizziness
in emergency departments because of limitations attendant
to time, space, laboratory tests and diagnostic procedures.
This study was performed with the goal of devising a protocol
to positively identify isolated dizziness at the bedside in
emergency departments.
Methods: We retrospectively reviewed the medical records
of 384 patients with isolated dizziness who visited the emergency
department of Kyunghee Medical Center from
January 1, 2006 to December 31, 2006. We analyzed age,
gender, the risk factors of cerebral vascular accident, neurologic
examinations, and features of dizziness and performed
a logistic regression analysis.
Results: In logistic regression analysis, age of at least 65
years, cerebral vascular accident history, disequilibrium
character, cranial nerve system, and tandem gait abnormality
were significantly associated with central dizziness.
Negative predictive value and sensitivity of the protocol
were 99.6% and 98.7%, respectively.
Conclusion: In patients presenting with isolated dizziness
in the emergency department, patients less than 65 years
old, and without history of cerebral vascular accident, disequilibrium
character, cranial nerve system, or tandem gait
abnormality can be safely discharged after conservative
management without further evaluation.

영어초록

Purpose: Dizziness is a common chief complaint in
patients presenting at emergency deparments. As central
dizziness can be life-threatening, it is important to differentiate
central from peripheral dizziness. VBI (vertebrobasilar
insufficiency) or PICA (posterior inferior cerebellar artery)
infarction can present as only isolated dizziness without
other neurologic symptoms, thus mimicking peripheral
dizziness. It is difficult to differentiate from isolated dizziness
in emergency departments because of limitations attendant
to time, space, laboratory tests and diagnostic procedures.
This study was performed with the goal of devising a protocol
to positively identify isolated dizziness at the bedside in
emergency departments.
Methods: We retrospectively reviewed the medical records
of 384 patients with isolated dizziness who visited the emergency
department of Kyunghee Medical Center from
January 1, 2006 to December 31, 2006. We analyzed age,
gender, the risk factors of cerebral vascular accident, neurologic
examinations, and features of dizziness and performed
a logistic regression analysis.
Results: In logistic regression analysis, age of at least 65
years, cerebral vascular accident history, disequilibrium
character, cranial nerve system, and tandem gait abnormality
were significantly associated with central dizziness.
Negative predictive value and sensitivity of the protocol
were 99.6% and 98.7%, respectively.
Conclusion: In patients presenting with isolated dizziness
in the emergency department, patients less than 65 years
old, and without history of cerebral vascular accident, disequilibrium
character, cranial nerve system, or tandem gait
abnormality can be safely discharged after conservative
management without further evaluation.

참고자료

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