- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
GRACE-3 guidelines for dizziness and vertigo management in ED, issued by SAEM
USA: The GRACE-3 panel has developed 15 evidence-based recommendations based on the timing and triggers of dizziness while recognizing that alternative diagnostic approaches exist.
The SAEM (Society for Academic Emergency Medicine) GRACE (Guidelines for reasonable and appropriate care in the emergency department) address the best practices for the care of the most common chief complaints that can be seen on the tracking board of any emergency department (ED) in the US based upon research and expert consensus.
Acute dizziness or vertigo is a common ED presentation, accounting for 2.1%–3.6% of visits per year, with an estimated annual cost approximating $10 billion in the United States, a large proportion of which is related to imaging. The GRACE-3 clinical practice guideline has been developed to address the critical need for evidence-based recommendations for patients presenting in the emergency department with acute dizziness and vertigo.
Most acutely dizzy patients in the ED present in one of three patterns that drive the differential diagnosis, diagnostic testing, and interpretation of many of these tests.
Grading of Recommendations Assessment, Development, and Evaluation (GRACE) was used to develop the GRACE-3 clinical practice guideline. The GRACE-3 panel developed 15 evidence-based recommendations based on the triggers and timing of dizziness; recommendations from the guideline are given below:
Training Emergency Clinicians to Perform Bedside Eye Movement Examinations
- Emergency clinicians should receive training for diagnosing and treating patients with acute dizziness.
Diagnosis of AVS
- In patients with nystagmus, trained clinicians should use HINTS testing to distinguish central (stroke) from peripheral (inner ear, usually vestibular neuritis) diagnoses.
- In patients with nystagmus, the hearing should be assessed by finger rub to distinguish central from peripheral diagnoses.
- In patients without nystagmus, assess the severity of gait unsteadiness to distinguish central from peripheral diagnoses.
- Routine use of non-contrast brain CT or CTA is not recommended in patients with or without nystagmus.
- In patients with or without nystagmus, the routine of use MRI or MRA as the first-line diagnostic test is not recommended if a clinician trained in HINTS is available.
- MRI/MRA use is recommended to distinguish between central and peripheral diagnoses in patients whose HINTS result is central or equivocal.
Diagnosis of s-EVS
- Clinicians should perform a history and physical exam with emphasis on cranial nerves, visual fields, eye movements, limb coordination, and gait assessment to distinguish between central (TIA) and peripheral (vestibular migraine, Menière disease) diagnoses.
- Use of CT is not recommended to distinguish between central and peripheral diagnoses.
- If concern for TIA, use CTA or MRA to diagnose large vessel pathology.
Diagnosis of the Triggered Episodic Vestibular Syndrome
- The use of the Dix-Hallpike test is recommended to diagnose posterior canal BPPV.
- Routine use of CT or CTA is not recommended.
- Routine use of MRI or MRA is not recommended for posterior canal BPPV by a positive Dix-Hallpike test.
Treatment of Acutely Dizzy Patients in the ED
- Use shared decision-making with patients regarding short-term steroid treatment for vestibular neuritis within the first three days of symptoms.
- Epley manoeuvre should be used for patients diagnosed with posterior canal BPPV.
Reference:
https://www.saem.org/publications/grace/grace-3
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751