Construction and Validation of the Vestibular Screening Tool for Use in the Emergency Department and Acute Hospital Setting

ObjectivesTo construct a new vestibular screening tool to identify likely vestibular disorders and guide referral of dizzy patients presenting to hospital and to test the vestibular screening tool for construct and discriminative validity and reliability of physiotherapy assessors.DesignMethodologic study.SettingEmergency and acute hospital wards of a metropolitan hospital.ParticipantsAdults (N=114) presenting to hospital with dizziness (mean age, 67.36±14.88y; 57% women).InterventionNot applicable.Main Outcome MeasuresThree vestibular screening tools (3, 4, and 5 items) were investigated. Physiotherapy vestibular diagnostic tests categorized patients as vestibular or nonvestibular patients. Subsets of patients were assessed twice by 2 physiotherapists (n=20) and twice by the same physiotherapist (n=30).ResultsEach of the vestibular screening tools had a good fit to the Rasch measurement model. Factor analysis demonstrated individual items loaded across 1 factor, confirming unidimensionality of the 3 vestibular screening tools, and Cronbach α determined internal consistency. The 4-item vestibular screening tool had the greatest area under the curve using receiver operator curve analysis (.894), with highest sensitivity (83%) and specificity (84%) for identifying vestibular disorders (cutoff value ≥4/8). Sensitivity of the 3- and 5-item versions was lower than the 4-item vestibular screening tool (80%). The 4-item vestibular screening tool scores showed high intrarater (κ item scores, .831–1; intraclass correlation coefficient [ICC] total, .988) and interrater (κ item scores, .578–.921; ICC total, .878) reliability.ConclusionsThe 4-item vestibular screening tool is a reliable, valid tool for screening dizzy patients presenting to hospital, with unidimensional construct validity, high sensitivity, and specificity for identifying likely vestibular disorders. The vestibular screening tool could be used clinically to streamline referrals of dizzy patients to vestibular clinics.