急性めまいのクリニカルパス

抄録

Managing acute vertigo in the emergency department (ED) presents several challenges: (1) emergency physicians must differentiate dangerous cases of vertigo; (2) determining the appropriate department to admit the patient to for undiagnosed, but admission-requiring vertigo can be difficult; (3) contacting and calling the on-call physician responsible for the hospitalized patient is necessary; and (4) significant time is required to manage cases where medically stable patients refuse to go home due to anxiety or social reasons. These issues place a heavy burden on the ED staff.

To address these challenges, we introduced a clinical pathway for the hospitalization of patients with acute vertigo. Dangerous causes of vertigo, such as cerebral infarction, are ruled out by obtaining brain MRI with diffusion-weighted imaging. The designated admitting department is otolaryngology. Emergency physicians can apply the pathway at their discretion without consulting an otolaryngologist. Eligible patients include those experiencing continuous vertigo for more than one hour. Additionally, patients who request hospitalization, even for social reasons, are also eligible.

The implementation of this pathway not only reduced the burden on the ED staff but also led to positive outcomes, including an increase in the number of hospitalized patients.