Epley maneuver for benign paroxysmal positional vertigo: Evidence synthesis for guidelines for reasonable and appropriate care in the emergency department.

Autor: Khoujah D; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Emergency Medicine, AdventHealth Tampa, Tampa, Florida, USA., Naples JG; Center, Division of Otolaryngology-Head & Neck Surgery, Beth, Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts, USA., Silva LOJE; Department of Emergency Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.; Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA., Edlow JA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA., Gerberi DJ; Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA., Carpenter CR; Department of Emergency Medicine, Washington University at St. Louis, St. Louis, Missouri, USA., Bellolio F; Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2023 Apr 26. Date of Electronic Publication: 2023 Apr 26.
DOI: 10.1111/acem.14739
Abstrakt: Background: Canalith repositioning maneuvers (such as the Epley maneuver) are recommended by specialty guidelines for management of benign paroxysmal positional vertigo (BPPV) yet are frequently underutilized in the emergency department (ED).
Methods: We conducted a systematic review of systematic reviews to summarize the evidence of Epley maneuver for the treatment of posterior canal (pc) BPPV in any setting. We included systematic reviews of randomized controlled trials (RCTs) that compared Epley to control in adult patients with pc-BPPV. Titles, abstracts, and full texts were screened in duplicate. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Meta-analysis of individual studies was conducted with random and fixed effects.
Results: From 2,228 titles, 7 systematic reviews were selected for quality assessment. One review was of higher methodological quality, included only RCTs, and was the most current and comprehensive. Five of the 11 RCTs of the review, including 312 patients with pc-BPPV diagnosed by Dix-Hallpike, were relevant to our question. Meta-analysis of 4 RCTs (251 patients) showed the use of Epley (as compared to control) was associated with higher complete resolution of vertigo at 1 week (OR 7.19, CI 1.52 to 33.98, moderate certainty). Meta-analysis of 3 RCTs (195 patients) showed the use of Epley was associated with higher conversion to negative Dix-Hallpike at 1 week (OR 6.67, CI 1.52 to 33.98, moderate certainty). The number-needed-to-treat was 3. Meta-analysis of the outcomes at 1 month, and when observational studies were included, showed similar results. No serious adverse effects were reported.
Conclusions: Symptoms of pc-BPPV improve with the Epley maneuver. Emergency clinicians should become familiar with performing the Epley for BPPV. Further studies on ED implementation and clinician education of Epley are needed.
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Databáze: MEDLINE
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