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{
    "pk": 8840,
    "title": "Emergency Physician Attitudes, Preferences, and Risk Tolerance for Stroke as a Potential Cause of Dizziness Symptoms",
    "subtitle": null,
    "abstract": "Introduction\n: We evaluated emergency physicians’ (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients.\nMethods\n: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness. We calculated descriptive statistics and post-test probabilities for such a clinical prediction rule.\nResults\n: The response rate was 68% (366/535). Respondents’ median practice tenure was eight years (37% female, 92% emergency medicine board certified). Symptom quality and typical vascular risk factors increased suspicion for stroke as a cause of dizziness. Most respondents reported obtaining head computed tomography (CT) (74%). Nearly all respondents used and felt confident using cranial nerve and limb strength testing. A substantial minority of EPs used the Epley maneuver (49%) and HINTS (head-thrust test, gaze-evoked nystagmus, and skew deviation) testing (30%); however, few EPs reported confidence in these tests’ bedside application (35% and 16%, respectively). Respondents favorably viewed applying a properly validated clinical prediction rule for assessment of immediate and 30-day stroke risk, but indicated it would have to reduce stroke risk to <0.5% to be clinically useful.\nConclusion\n: EPs report relying on symptom quality, vascular risk factors, simple physical exam elements, and head CT to diagnose stroke as the cause of dizziness, but would find a validated clinical prediction rule for dizziness helpful. A clinical prediction rule would have to achieve a 0.5% post-test stroke probability for acceptability.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "stroke, clinical prediction rules, dizziness,"
        }
    ],
    "section": "Diagnostic Acumen",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/2dk9b386",
    "frozenauthors": [
        {
            "first_name": "Dustin",
            "middle_name": "W.",
            "last_name": "Ballard",
            "name_suffix": "",
            "institution": "The Permanente Medical Group; Kaiser Permanente San Rafael Medical Center, Department of Emergency Medicine, San Rafael, California; Kaiser Permanente Northern California, Division of Research, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "R.",
            "last_name": "Vinson",
            "name_suffix": "",
            "institution": "The Permanente Medical Group; Kaiser Permanente Northern California, Division of Research, Oakland, California; Kaiser Permanente Roseville Medical Center, Department of Emergency Medicine, Roseville, California",
            "department": "None"
        },
        {
            "first_name": "Adina",
            "middle_name": "S.",
            "last_name": "Rauchwerger",
            "name_suffix": "",
            "institution": "Kaiser Permanente Northern California, Division of Research, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "Hilary",
            "middle_name": "R.",
            "last_name": "Iskin",
            "name_suffix": "",
            "institution": "Kaiser Permanente Northern California, Division of Research, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "Anthony",
            "middle_name": "S",
            "last_name": "Kim",
            "name_suffix": "",
            "institution": "Department of Neurology, University of California, San Francisco, San Francisco, California",
            "department": "None"
        },
        {
            "first_name": "Mamata",
            "middle_name": "V.",
            "last_name": "Kene",
            "name_suffix": "",
            "institution": "The Permanente Medical Group; Kaiser Permanente Fremont Medical Center, Department of Emergency Medicine, Fremont, California",
            "department": "None"
        }
    ],
    "date_submitted": "2015-04-03T18:09:27Z",
    "date_accepted": "2015-04-03T18:09:27Z",
    "date_published": "2015-10-20T23:11:46Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8840/galley/5041/download/"
        }
    ]
}