Pharmacist Utilization of the DIE Test to Assess Aminoglycoside Vestibulotoxicity

Context

Aminoglycoside antibiotics can cause irreversible vestibulotoxicity, which has debilitating effects on balance and vision. The dynamic illegible E (DIE) test was developed to screen for signs of vestibulotoxicity and prevent permanent vestibular damage and is currently being conducted by the neurophysiologist.

Objectives

The primary goal of this study was to show that a pharmacist can perform the DIE test for vestibulotoxicity with equivalent accuracy to the neurophysiologist.  The secondary goals were to determine the workload of conducting the DIE test and to correlate patient variables to vestibular toxicity.

Setting

A tertiary Care 1000-bed university-affiliated Hospital.

Design

All patients initiated on aminoglycoside therapy were screened over a 12-week period.  All patients greater than 18 years of age and prescribed aminoglycoside therapy for more than 7 days were evaluated for DIE test administration.  Patients were excluded if they were unable to sit up to perform the test, unable to read at least the top four rows of the test chart due to visual impairment or mental incompetence, had a language barrier without a translator available or had a medical contraindication to neck manipulation.  Eligible patients were tested first by the primary investigator then retested by the neurophysiologist within 72 hours.

Main Outcome Measures

The primary goal was to show that a pharmacist can perform the DIE test for vestibulotoxicity with equivalent accuracy to the neurophysiologist.  The secondary goals were to determine the workload of conducting the DIE test and to correlate patient variables to vestibular toxicity.

Results

Two hundred and thirteen patients were screened with 39 receiving aminoglycosides for more than 7 days.  Fifteen patients were excluded due to medical condition or discharge from hospital before testing and 24 were tested by the primary investigator.  The neurophysiologist was not able to retest 7 of these patients therefore 17 patients were included in the analysis. There was a 100% correlation between the results of the primary investigator and the neurophysiologist.  There were no positive test results (score ³ 3), therefore no patients with vestibulotoxicity. No aminoglycoside doses were supratherapeutic and there were no changes in baseline patient variables such as serum creatinine or blood urea nitrogen.  The DIE test took less than 3 minutes to administer.  On average, only 2-3 patients per week would require this test resulting in a minimal increase in pharmacist workload.

Conclusions

A pharmacist can perform the DIE test with equivalent accuracy to the control tester and incorporate this monitoring technique into the scope of their daily activities.

Latest Posts