Year of Publication

2018

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Lindsey Siewert

Committee Member

Dr. Carol Thompson

Committee Member

Dr. Regina Hymer

Abstract

PURPOSE: The purpose of this study was to evaluate and describe any correlations between subjective dizziness, gait ataxia, and posterior circulation stroke in the setting of gait assessment as an evidence-based standard of care in the emergency department.

METHODS: This study was a two-center, descriptive, retrospective and prospective medical record review. The sample consisted of adult patients presenting to the emergency departments at two tertiary facilities within a large metropolitan healthcare system with chief complaints of subjective dizziness. The study period was February 1, 2018 through July 31, 2018. The data set was retrieved via data retrieval specialists.

RESULTS: A total of 1,091 patients meeting inclusion criteria presented to the study sites with subjective dizziness. Gait assessment documentation occurred 29 times (2.7 percent). Ataxia per ICD-10 coding was diagnosed in 10 cases (0.9 percent). Zero posterior circulation stroke diagnoses per ICD-10 coding were found in this sample. No association was found between gait ataxia and posterior circulation stroke in this study.

CONCLUSION: Findings in the sample studied did not support the literature-based assumption that subjectively dizzy patients who undergo gait assessment may be ataxic due to posterior circulation stroke. Current literature continues to recommend gait assessment when appropriate, as well as other more sensitive assessments for management of the dizzy population and diagnosis of posterior circulation stroke. Clinical application of new evidence-based assessments must be implemented and studied to determine efficacy and improve posterior circulation stroke assessment, diagnosis, and treatment.

Key words: subjective dizziness, emergency department, gait assessment, gait ataxia, posterior circulation stroke

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