Diagnostic accuracy of the STANDING algorithm in patients with isolated vertigo: a multicentre prospective study (STANDING-M).
Ronchetti M,et al. Emerg Med J. 2025 Nov 21;42(12):791-797. doi: 10.1136/emermed-2025-214902.
Methodology: 4/5
Usefulness: 2.5/5
Question and Methods: This is a multi-center prospective trial, where the goal was to compare the diagnosis of patients who present with vertigo/dizziness via STANDING or usual care.
Findings: The STANDING algorithm showed high specificity (91.6%) and excellent rule-out ability (NPV 99%), with a positive likelihood ratio of 10.4 and negative likelihood ratio of 0.1; the use of this algorithm reduces unnecessary imaging and emergency department length of stay compared with usual care.
Limitations: Overall, there were a small number of central vertigo cases, they do not report the interrater reliability for STANDING in this trial and only a small number of patients had gold standard head imaging (MRI).
Interpretation: The standing algorithm appears to perform well and could be used as a rule out test (limiting the need for scans and shortening ED length of stay), but it likely will not be implemented in our center due to the need for training, extra tools (frenzel lenses) and a comparable algorithm or approach that is already in use here.
