{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:51:49Z","timestamp":1791402709592,"version":"4.3.3"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,3,10]],"date-time":"2015-03-10T00:00:00Z","timestamp":1425945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To validate a clinical diagnostic tool, used by emergency physicians (<jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content>), to diagnose the central cause of patients presenting with vertigo, and to determine interrater reliability of this tool.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A convenience sample of adult patients presenting to a single academic ED with isolated vertigo (i.e. vertigo without other neurological deficits) was prospectively evaluated with <jats:styled-content style=\"fixed-case\">STANDING<\/jats:styled-content> (<jats:bold><jats:styled-content style=\"fixed-case\">S<\/jats:styled-content><\/jats:bold>pon<jats:bold><jats:styled-content style=\"fixed-case\">TA<\/jats:styled-content><\/jats:bold>neous<jats:bold><jats:styled-content style=\"fixed-case\">N<\/jats:styled-content><\/jats:bold>ystagmus, <jats:bold><jats:styled-content style=\"fixed-case\">D<\/jats:styled-content><\/jats:bold>irection, head <jats:bold><jats:styled-content style=\"fixed-case\">I<\/jats:styled-content><\/jats:bold>mpulse test, standi<jats:bold><jats:styled-content style=\"fixed-case\">NG<\/jats:styled-content><\/jats:bold>) by five trained <jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content>. The first step focused on the presence of spontaneous nystagmus, the second on the direction of nystagmus, the third on head impulse test and the fourth on gait. The local standard practice, senior audiologist evaluation corroborated by neuroimaging when deemed appropriate, was considered the reference standard. Sensitivity and specificity of <jats:styled-content style=\"fixed-case\">STANDING<\/jats:styled-content> were calculated. On the first 30 patients, inter\u2010observer agreement among <jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content> was also assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five <jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content> with limited experience in nystagmus assessment volunteered to participate in the present study enrolling 98 patients. Their average evaluation time was 9.9 \u00b1 2.8\u2009min (range 6\u201317). Central acute vertigo was suspected in 16 (16.3%) patients. There were 13 true positives, three false positives, 81 true negatives and one false negative, with a high sensitivity (92.9%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 70\u2013100%) and specificity (96.4%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 93\u201338%) for central acute vertigo according to senior audiologist evaluation. The Cohen's kappas of the first, second, third and fourth steps of the <jats:styled-content style=\"fixed-case\">STANDING<\/jats:styled-content> were 0.86, 0.93, 0.73 and 0.78, respectively. The whole test showed a good inter\u2010observer agreement (k = 0.76, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.45\u20131).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the hands of <jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">STANDING<\/jats:styled-content> showed a good inter\u2010observer agreement and accuracy validated against the local standard of care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.12372","type":"journal-article","created":{"date-parts":[[2015,3,10]],"date-time":"2015-03-10T08:49:20Z","timestamp":1425977360000},"page":"126-131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Can emergency physicians accurately and reliably assess acute vertigo in the emergency department?"],"prefix":"10.1111","volume":"27","author":[{"given":"Simone","family":"Vanni","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiman","family":"Nazerian","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Casati","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Moroni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Risso","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Ottaviani","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudi","family":"Pecci","sequence":"additional","affiliation":[{"name":"Department of Audiology Clinic Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Pepe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vannucchi","sequence":"additional","affiliation":[{"name":"Department of Audiology Clinic Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Grifoni","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Careggi University Hospital  Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,3,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3233\/VES-2009-0343"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.4065\/83.7.765"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.4065\/82.11.1329"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000240329.48263.0d"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(89)80524-4"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2008.08.022"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.551234"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.100174"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00189.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2011.01093.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00523.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410190312"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70216-3"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000073861"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2008.09.002"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000314685.01433.0d"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1159\/000320256","article-title":"Acute vertigo with double vision \u2013 brainstem stroke or stroke mimic?","volume":"30","author":"Schlaeger R","year":"2010","journal-title":"Cerebrovasc. 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