vHIT Testing for Presentation of Dizziness at a Comprehensive Stroke Center

Medical University of South Carolina30 enrolled

Overview

The purpose of this study is to evaluate the sensitivity and specificity of the video head impulse test (vHIT) device, when implemented in the acute ED setting to identify acute ischemic stroke or central pathology vs peripheral vestibular dysfunction in patient's presenting with vertigo. This study will evaluate the implementation of the device, consistency with current diagnostic standards, unnecessary administration of antithrombolytics and will further study the reduction in hospital admissions and overall healthcare costs.

In the proposed study, subjects admitted to the Emergency Department (ED) with symptoms of dizziness, concerning for an acute ischemic stroke, will undergo routine triage (bedside neurologic examination, head impulse testing, CT scan) and will then be tested with a vHIT device to attempt to further identify the cause of dizziness, after standard of care testing has been performed. The clinician performing the vHIT will be blinded to the result of the CT scan before entering their report.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

SINGLE

Enrollment

Conditions

Stroke, Acute Vertigo Vertigo, Peripheral

Interventions

Video Head Impulse TestingDEVICE

During vHIT testing a commercially available mono-ocular video oculography system will be donned on the patient. (Interacoustics EyeSeeCam vHIT 3rd Generation Tests: VOR of lateral, RALP, \& LARP canals. SW: 3rd generation VE525 software. HW: laptop PC, lightweight monocular video goggles). Subjects will be instructed to maintain fixation at a target from 1 m distance. A study team member will deliver at least 5 head impulses per side (10-20° angle, duration 150-200 ms, peak velocity of \>150°/s) in the horizontal and vertical planes with unpredictable timing and direction. A neurotologist will then evaluate the VOR gain or the ratio of eye velocity over-head velocity. The presence of refixation (catch-up) saccades, either overt or covert, will be evaluated by the study team. In line with previous literature, the vHIT testing will be considered to be abnormal if VOR gain is \<0.8 in the presence of refixation saccades .

Standard of care neurologic evaluationOTHER

A standard neurologic evaluation will be performed including a National Institute of Health Stroke Scale and imaging if symptoms and NIHSS warrant.

Outcomes

Primary Outcomes

Sensitivity & Specificity of vHIT device

Sensitivity and specificity of the vhit to detect peripheral vestibular dysfunction in an acute presentation of vertigo

Time frame: This will be performed once all results are compiled, not to exceed 90 days after study completion.

Secondary Outcomes

Time to perform testing

The time it takes to perform vHIT testing on a participant admitted for dizziness in the hospital environment.

Time frame: From time the study team member arrives to patient's location until vHIT testing is complete, not to exceed 1 hour.

Predictive Value

We will measure positive predicitive value of vHIT to determine peripheral vestibular involvement in a participant who presents with dizziness.

Time frame: At the time results are compared from vHIT testing to CT scan, not to exceed 30 days post testing.

Cost Analysis

We will examine the cost reduction that would have occured if vhit was incorporated in decision making for stroke workup and/or hospital admission