Ignite Creation Date:
2024-05-06 @ 8:16 PM
Last Modification Date:
2024-10-26 @ 3:24 PM
Study NCT ID:
NCT06314581
Status:
ACTIVE_NOT_RECRUITING
Last Update Posted:
2024-05-30
First Post:
2024-03-11
Brief Title:
Effect of a Multifaceted Educational Intervention on the Implementation of Evidence-based Practices for Benign Paroxysmal Positional Vertigo in an Emergency Department
Sponsor:
Fondation Hôpital Saint-Joseph
Organization:
Fondation Hôpital Saint-Joseph
Study Overview
Official Title:
Effect of a Multifaceted Educational Intervention on the Implementation of Evidence-based Practices for Benign Paroxysmal Positional Vertigo in an Emergency Department
Status:
ACTIVE_NOT_RECRUITING
Status Verified Date:
2024-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
BPPV-Teaching
Brief Summary:
Acute vertigo accounts for around 4 of emergency room visits Triggered episodic vestibular syndrome is the most commonly encountered symptomatic context BPPV Benign Paroxysmal Positional Vertigo is the main cause representing 40-50 of the vertigo cases assessed in emergency departments It results from the migration of calcium carbonate particles otoliths from the sticky membrane of the utricle and saccule of the inner ear to one of the 3 semicircular canals SCC posterior horizontal or lateral and anterior It occurs idiopathically with head movement through degeneration or following head trauma The otolith impulse causes the endolymph to move temporarily and aberrantly displacing the cup of the affected canal resulting in the transmission of erroneous information to the vestibular nuclei This leads to the sudden onset of vertigo and eye deviation resulting in transient nystagmus The location of the displaced otoliths determines the variant of BPPV BPPV of the posterior semicircular canal is the most common around 65 of BPPVs followed by BPPV of the horizontal canal while BPPV of the anterior canal is rare as it resolves spontaneously and rapidly Although a benign condition BPPV leads 9 times out of 10 to a medical consultation interruption of daily activities or sick leave Untreated it will usually recur and can impact on patients quality of life
Detailed Description:
Recommendations for the appropriate management of vertigo in emergency departments published in 2023 reaffirmed that the management of BPPV is based solely on the clinic There is no imaging test that can confirm the presence of otoliths migrating to a semicircular canal during head movement BPPV should be suspected in the presence of an episodic vestibular syndrome triggered by head movements and more broadly in the presence of brief vertigo without a clear cause and without spontaneous or lateral facing nystagmus The diagnosis of posterior BPPV is made when vertigo is accompanied by transient vertical torsional nystagmus on the Dix-Hallpike test In some cases of BPPV the Dix-Hallpike test produces vertigo but not transient nystagmus This phenomenon is known as subjective BPPV and may affect up to a quarter of patients suspected of having BPPV It can be explained by a low otolith load in the affected canal by spontaneous healing by otolith egress from the canal but also by poor technique on the part of the clinician slow maneuver or faulty final position In patients with a typically positive Dix-Hallpike result or subjective BPPV 1st-line treatment is based on a canalith repositioning maneuver The modified Epley maneuver is the recommended one and its efficacy is supported by numerous meta-analyses It is significantly associated with complete resolution of symptoms after 7 days Horizontal BPPV should be suspected by the presence of transient horizontal nystagmus in the Dix-Hallpike test The Supine Head Roll test then confirms the diagnosis with the appearance of vertigo and transient horizontal geo- or ageo-tropic nystagmus The preferred treatment maneuver is Lemperts Barbecue maneuver This management strategy can be summarized in a decision tree As posterior BPPV is the most common the appropriate use of the Dix-Hallpike and Epley maneuvers has a positive effect on a large majority of BPPV patients in emergency departments In terms of clinical decision rules the management of vertigo has been mentioned as the 1st priority of emergency physicians However numerous studies have highlighted the fact that their clinical approach is often inappropriate and leads to underdiagnosis of BPPV Under-diagnosis is generally due to failure to verify the existence of spontaneous nystagmus under-use of the Dix-Hallpike test or its misuse While BPPV is a common and easily treatable condition its diagnosis and treatment are largely delayed by a lack of theoretical knowledge and clinical skills among physicians
Understanding the orientation of the vestibular apparatus and how it is stimulated is difficult learning Traditional lecture-based learning appears to have little gain in terms of skill acquisition This approach is tedious and offers little opportunity to acquire clinical skills Theoretical resources do exist in particular the BPPV Viewer software which offers 3D modeling of the vestibular apparatus and the demonstration videos by Prof Peter Johns available on Youtube could provide a fairly clear theoretical basis Proposing new teaching methods could be one way of solving the problem of sub-optimal management of BPPV and the resulting under-diagnosis Two original teaching methods have been published one using demonstrations involving students to teach vestibular physiology the other based on Gagnes 9 event The retention and transfer of knowledge to the bedside needs to be investigated
Understanding the orientation of the vestibular apparatus and how it is stimulated is difficult learning Traditional lecture-based learning appears to have little gain in terms of skill acquisition This approach is tedious and offers little opportunity to acquire clinical skills Theoretical resources do exist in particular the BPPV Viewer software which offers 3D modeling of the vestibular apparatus and the demonstration videos by Prof Peter Johns available on Youtube could provide a fairly clear theoretical basis Proposing new teaching methods could be one way of solving the problem of sub-optimal management of BPPV and the resulting under-diagnosis Two original teaching methods have been published one using demonstrations involving students to teach vestibular physiology the other based on Gagnes 9 event The retention and transfer of knowledge to the bedside needs to be investigated
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None