Disconnect between available literature and clinical practice: Exploring gaps in the management of t-BPPV in the emergency department

Abstract

Background: Healthcare costs associated with the diagnosis of benign paroxysmal positional vertigo (BPPV) alone approach $2 billion per year in the United States. Post-traumatic BPPV (t-BPPV) is well recognized, and can be managed with simple bedside physical maneuvers. Despite the availability of literature and clear guidelines supporting this approach, physical maneuvers are underutilized. The aim of this study was to explore the reasons for this practice disagreement. Methods: A cross-sectional survey of emergency physicians (EP) and non-emergency physicians (Non-EPs) managing head injury patients was conducted. The survey questions were aimed to explore the attitude of these frontline healthcare providers towards the diagnosis and management of t-BPPV in head injury patients. Results: A total of 102 physicians completed the survey. Of them, male physicians constituted 87.2%, and the majority were working as emergency physicians (80.4%). Although nearly three-fourths (72.5%; n = 74) of the participants admitted that it is important to explore the possibility of t-BPPV in patients with head injury, only one-fifth of the participating physicians (20.6%; 21 of 102) confirmed that they would investigate for t-BPPV. A lack of knowledge about t-BPPV in more than half of the study participants (55.9%; n = 57) was the main reason for them not probing the possibility of t-BPPV. Conclusion: To close the gap between available evidence-based guidelines and actual clinical practice, there is a need for raising awareness about this condition. Addressing the training needs of frontline healthcare providers to use physical maneuvers such as Dix–Hallpike (DHM) and canalith repositioning (CRP) maneuvers in the management of t-BPPV is an important step that needs to be taken.