Does This Dizzy Patient Have a Serious Form of Vertigo? Comment and Correction

Winston Warr, MD, MPH
JAMA. 1994;272(17):1323-1324. doi:10.1001/jama.1994.03520170033017.
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To the Editor.  —The article by Dr Froehling and colleagues1 addressing the clinical examination of patients with dizziness has severe limitations. The authors rely on a study by Herr et al2 that has serious faults: only 46% of the eligible patients were enrolled in that study, the authors were unable to follow up on 16% of the patients after they left the emergency department to see if serious causes of dizziness were missed, and the criterion standard for determining the presence or absence of a serious cause of illness was the physician's diagnosis and 16% of the diagnoses had to be changed in retrospect.Froehling et al state, in referring to the study by Herr et al, "Patients who had the highly specific cluster of positive results on the head-hanging test and either vertigo or vomiting almost always had a nonurgent peripheral vertigo (a finding with high specificity,


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