Acute Video-oculography for Vertigo in Emergency Rooms for Rapid Triage (AVERT)

Exclusion Criteria

• •1. Excluded from Pre-Randomization Screening
• •* Level 1 trauma or critical illness
• •* Altered mental status (e.g., delirium, dementia) that would preclude active study participation (this includes patients with abnormal mental state due to alcohol intoxication or illicit substance, which are known, easily-recognized causes of dizziness or vertigo presentations to the ED)
• •* Non-English speaking (enrollment of non-English speakers is not feasible given the logistics of identifying a translator and the need for rapid recruitment and randomization in the AVERT study; furthermore, the terms vertigo, dizziness, and unsteadiness may have different meanings in other languages)
• •* Known pregnancy (all women of childbearing age who are enrolled will undergo a urine or serum beta human chorionic gonadotropin \[hCG\] pregnancy test prior to MRI to confirm no pregnancy, per local institutional guidelines)
• •* Unable or unsafe to participate in screening, including VOG tests (as deemed by specific pre-enrollment risk assessment questions or ED provider and/or Study Coordinator judgment) including, but not limited to:
• •* visual impairment sufficient to prevent visual fixation during the VOG testing
• •* clinically-perceived risk to patient of participating in study (ED provider or staff concerns)
• •* clinically-perceived risk to research staff (e.g., violence, blood/body fluid/respiratory precautions)
• •* unstable cardiac status (given a single reported case of bradycardia with impulse testing)
• •* acute cranio-cervical trauma or other condition (e.g., rheumatoid arthritis) that might lead to instability of the cervical spine that would be a contraindication to neck rotation during VOG testing
• •* Obvious general medical cause (as judged by treating ED provider) including, but not limited to, acute myocardial infarction, pulmonary embolus, pneumonia, urinary tract infection, drug intoxication, etc.
• •2. Excluded from Randomization (Eligible for Observational Arm Follow-up)
• •* Patient previously randomized in the AVERT Trial (previously screened but not randomized are eligible)
• •* Unable to participate fully with study follow-up (particularly MRI) including, but not limited to:
• •* unable to return for follow-up testing within 30 days
• •* unable to undergo MRI because of contraindications (e.g., pacemaker, metallic foreign body, pregnancy) or other reasons (severe claustrophobia, too large or too heavy for MRI scanner)