Diagnostic and therapy gaps in BPPV care: a retrospective analysis and feasibility evaluation across a London NHS trust
4 affiliations
- 1Kings College Hospital NHS Foundation Trust
- 2Department of Brain Sciences, Charing Cross Hospital, Imperial College London
- 3Department of Biomedical Engineering, School of Biomedical Engineering and Imagine Sciences, Kings College London
- 4National Hospital for Neurology and Neurosurgery, Queen Square
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is the most prevalent cause of peripheral dizziness, yet it remains poorly assessed and treated in acute settings. Despite the availability of validated bedside tools such as the Dix-Hallpike test (DHT) and canal repositioning manoeuvres (CRM) such as the Epley, diagnostic variability is high, neuroimaging is overused, and vestibular suppressants are frequently prescribed. This two-part evaluation characterised BPPV assessment and management across a London NHS Trust and assessed the feasibility of incorporating DHT into an existing AHP-led falls pathway within the emergency department (ED).
Methods: A two-part evaluation was conducted across a large London NHS teaching hospital. Part 1 comprised a retrospective review of electronic patient records to characterise current BPPV assessment and management practices and identify potential service gaps. Part 2 was a prospective feasibility study evaluating the incorporation of AHP-led DHT screening into routine falls assessments for patients aged ≥65 years presenting to the ED.
Results: Part 1 identified 128 cases (mean age 63.4 years; 61.7% female). BPPV was the most common discharge diagnosis, 45.3% (95% CI 37.0–53.9%), yet full assessment and treatment were documented in only 14.8% of cases (95% CI 9.7–22.0%). Vestibular suppressants were prescribed in 43.8%, neuroimaging performed in 71.9 and 18.8% left without a definitive diagnosis. Readmission for dizziness within three months occurred in 13.3% (95% CI 8.5–20.2%). Part 2 included 102 patients, 79 with complete records (mean age 84.6 years; 54% female). DHT was completed in 62% (63/102 attempts; 95% CI 52.1–70.6%); BPPV was identified in 8% (95% CI 4.0–14.7%) and all received CRM. No dizziness-related readmissions occurred at three months.
Conclusion: This evaluation identifies consistent gaps in acute BPPV assessment and management, including overuse of neuroimaging and vestibular suppressants alongside underutilisation of validated bedside tools. Physiotherapy led DHT screening is feasible in a busy ED setting, even in older adults with multiple comorbidities, and the absence of readmissions in this small feasibility cohort is an encouraging finding that warrants evaluation in a larger, controlled cohort.
Related
- A prospective cross-sectional diagnostic feasibility study: musculoskeletal ultrasound for pediatric bone age evaluation
- Benchmarking time series foundation models for multi-country infectious disease forecasting: a retrospective evaluation across over 70 diseases
- Diagnostic performance, implementation fidelity, and costs of the World Health Organization three-test HIV testing strategy in Malawi: a national retrospective evaluation
- Evaluation of time to antibiotic therapy after implementation of an updated rapid diagnostic test for gram-negative bacteremia
- Diagnostic evaluation of suspected local anesthetic allergy in adults: a 6-year retrospective study
BibTeX
@article{tahtis2026diagnostic,
title = {{Diagnostic and therapy gaps in BPPV care: a retrospective analysis and feasibility evaluation across a London NHS trust}},
author = {Vassilios Tahtis and Abigail Beddard and Jessica Spall and Caroline Hare and James E. Scott and Lisa-Jane Fowler and Rebecca M. Smith and Yee Mah and Diego Kaski},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1950987},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1950987/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic and therapy gaps in BPPV care: a retrospective analysis and feasibility evaluation across a London NHS trust
AU - Vassilios Tahtis
AU - Abigail Beddard
AU - Jessica Spall
AU - Caroline Hare
AU - James E. Scott
AU - Lisa-Jane Fowler
AU - Rebecca M. Smith
AU - Yee Mah
AU - Diego Kaski
PY - 2026
DA - 2026/10/14
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1950987
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1950987/full
AB - Background: Benign paroxysmal positional vertigo (BPPV) is the most prevalent cause of peripheral dizziness, yet it remains poorly assessed and treated in acute settings. Despite the availability of validated bedside tools such as the Dix-Hallpike test (DHT) and canal repositioning manoeuvres (CRM) such as the Epley, diagnostic variability is high, neuroimaging is overused, and vestibular suppressants are frequently prescribed. This two-part evaluation characterised BPPV assessment and management across a London NHS Trust and assessed the feasibility of incorporating DHT into an existing AHP-led falls pathway within the emergency department (ED). Methods: A two-part evaluation was conducted across a large London NHS teaching hospital. Part 1 comprised a retrospective review of electronic patient records to characterise current BPPV assessment and management practices and identify potential service gaps. Part 2 was a prospective feasibility study evaluating the incorporation of AHP-led DHT screening into routine falls assessments for patients aged ≥65 years presenting to the ED. Results: Part 1 identified 128 cases (mean age 63.4 years; 61.7% female). BPPV was the most common discharge diagnosis, 45.3% (95% CI 37.0–53.9%), yet full assessment and treatment were documented in only 14.8% of cases (95% CI 9.7–22.0%). Vestibular suppressants were prescribed in 43.8%, neuroimaging performed in 71.9 and 18.8% left without a definitive diagnosis. Readmission for dizziness within three months occurred in 13.3% (95% CI 8.5–20.2%). Part 2 included 102 patients, 79 with complete records (mean age 84.6 years; 54% female). DHT was completed in 62% (63/102 attempts; 95% CI 52.1–70.6%); BPPV was identified in 8% (95% CI 4.0–14.7%) and all received CRM. No dizziness-related readmissions occurred at three months. Conclusion: This evaluation identifies consistent gaps in acute BPPV assessment and management, including overuse of neuroimaging and vestibular suppressants alongside underutilisation of validated bedside tools. Physiotherapy led DHT screening is feasible in a busy ED setting, even in older adults with multiple comorbidities, and the absence of readmissions in this small feasibility cohort is an encouraging finding that warrants evaluation in a larger, controlled cohort.
SN - 1664-2295
ER -