{
  "abstract": "Background This study aimed to evaluate the diagnostic accuracy of the STANDING algorithm for central vertigo across different emergency departments (EDs). Secondary outcomes compared STANDING with usual care in terms of diagnostic accuracy, resource utilisation and length of stay (LOS).Methods We prospectively enrolled adult patients presenting with vertigo at one ‘hub’ and three ‘spoke’ EDs in Tuscany. Patients were assessed using either STANDING or ‘usual care’, depending on the availability of a trained emergency physician. Imaging tests, consultations and dispositions were made independently of the study. The final diagnosis of central vertigo was determined by an expert panel, based on clinical data, along with a 30-day follow-up.Results A total of 456 patients were included, with 242 (53%) assessed by STANDING. There were no statistically significant differences in age, gender or cardiovascular risk factors between the STANDING and usual care groups. The prevalence of central vertigo was 8.6%, with ischaemic stroke (4.2%) as the leading cause, with no differences between groups. The STANDING algorithm had a sensitivity of 88.2%, specificity of 91.6%, positive predictive value of 44.1%, and negative predictive value of 99%. Usual care showed lower specificity and positive predictive value (36.5% and 14.7%, respectively, p<0.05). Additionally, the STANDING group had both fewer non-contrast head CT (NCCT) requests (48.3% vs 66.8%) and a shorter LOS (median 271 vs 339 min) (p<0.05).Conclusions The STANDING algorithm demonstrated high diagnostic accuracy and a very high negative predictive value for central vertigo across EDs and appears to be associated with improved specificity, reduced use of NCCT and shorter LOS compared with ‘usual care’.",
  "authors": [
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy"
      ],
      "name": "Mattia Ronchetti"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda USL Empoli, Florence, Italy"
      ],
      "name": "Paola Bartalucci"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda USL Toscana Nord Ovest, Viareggio, Italy"
      ],
      "name": "Giuseppe Pepe"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy"
      ],
      "name": "Giulia Canaroli"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Azienda USL Toscana centro, Firenze, Italy"
      ],
      "name": "Simone Magazzini"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Azienda USL Toscana centro, Firenze, Italy"
      ],
      "name": "Ersilia De Curtis"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda USL Toscana Nord Ovest, Viareggio, Italy"
      ],
      "name": "Federico Di Sacco"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Azienda USL Toscana centro, Firenze, Italy"
      ],
      "name": "Maurizio Bartolucci"
    },
    {
      "affiliations": [
        "Azienda Ospedaliero Universitaria Careggi, Florence, Italy",
        "Audiology Clinic, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Rudi Pecci"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda USL Empoli, Florence, Italy"
      ],
      "name": "Claudia Casula"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Lorenzo Pelagatti"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Ginevra Fabiani"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Andrea Pavellini"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Cosimo Caviglioli"
    },
    {
      "affiliations": [
        "Emergency Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Peiman Nazerian"
    },
    {
      "affiliations": [
        "Audiology Clinic, Azienda Ospedaliero Universitaria Careggi, Florence, Italy"
      ],
      "name": "Paolo Vannucchi"
    },
    {
      "affiliations": [
        "Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy"
      ],
      "name": "Simone Vanni"
    },
    {
      "affiliations": [],
      "name": "On behalf of the National Study and Research Center of SIMEU, Società Italiana di Medicina d’Emergenza Urgenza"
    }
  ],
  "title": "Diagnostic accuracy of the STANDING algorithm in patients with isolated vertigo: a multicentre prospective study (STANDING-M)",
  "uid": "f082da4c-7b1c-5b2f-9678-7376f9c3730b"
}