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Diagnostic accuracy of the STANDING algorithm in patients with isolated vertigo: a multicentre prospective study
Mattia Ronchetti1, Paola Bartalucci2, Giuseppe Pepe3
1Emergency Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
Emergency Medicine Journal : EMJ
|July 29, 2025
Summary
The STANDING algorithm accurately diagnoses central vertigo in emergency departments, showing high sensitivity and specificity. It also reduces CT scans and hospital stay compared to usual care.
Area of Science:
- Emergency Medicine
- Neurology
- Diagnostic Accuracy
Background:
- Central vertigo diagnosis in emergency departments (EDs) can be challenging.
- The STANDING algorithm was developed to aid in diagnosing central vertigo.
- Evaluating its accuracy across diverse ED settings is crucial.
Purpose of the Study:
- To assess the diagnostic accuracy of the STANDING algorithm for central vertigo in EDs.
- To compare STANDING with usual care regarding diagnostic accuracy, resource use, and length of stay (LOS).
Main Methods:
- Prospective enrollment of adult vertigo patients in hub and spoke EDs.
- Assessment using either the STANDING algorithm or usual care.
- Final diagnosis by an expert panel with 30-day follow-up.
Main Results:
- STANDING showed high diagnostic accuracy: 88.2% sensitivity, 91.6% specificity, 99% negative predictive value.
- Central vertigo prevalence was 8.6%, with ischemic stroke being the leading cause.
- STANDING group had fewer CT scans (48.3% vs 66.8%) and shorter LOS (271 vs 339 min).
Conclusions:
- The STANDING algorithm demonstrates high diagnostic accuracy for central vertigo in EDs.
- It offers improved specificity and reduced resource utilization (CT scans, LOS) compared to usual care.
- STANDING is a valuable tool for managing patients with vertigo in emergency settings.
