Increased Risk of Vascular Events in Emergency Room Patients Discharged Home with Diagnosis of Dizziness or Vertigo: A 3-Year Follow-Up Study

Abstract

BackgroundDizziness and vertigo symptoms are commonly seen in emergency room (ER). However, these patients are often discharged without a definite diagnosis. Conflicting data regarding the vascular event risk among the dizziness or vertigo patients have been reported. This study aims to determine the risk of developing stroke or cardiovascular events in ER patients discharged home with a diagnosis of dizziness or vertigo.MethodologyA total of 25,757 subjects with at least one ER visit in 2004 were identified. Of those, 1,118 patients were discharged home with a diagnosis of vertigo or dizziness. A Cox proportional hazard model was performed to compare the three-year vascular event-free survival rates between the dizziness/vertigo patients and those without dizziness/vertigo after adjusting for confounding and risk factors.ResultsWe identified 52 (4.7%) vascular events in patients with dizziness/vertigo and 454 (1.8%) vascular events in patients without dizziness/vertigo. ER patients discharged home with a diagnosis of vertigo or dizziness had 2-fold (95% confidence interval [CI], 1.35–2.96; p<0.001) higher risk of stroke or cardiovascular events after adjusting for patient characteristics, co-morbidities, urbanization level of residence, individual socio-economic status, and initially taking medications after the onset of dizziness or vertigo during the first year.ConclusionsER patients discharged home with a diagnosis of dizziness or vertigo were at a increased risk of developing subsequent vascular events than those without dizziness/vertigo after the onset of dizziness or vertigo. Further studies are warranted for developing better diagnostic and follow-up strategies in increased risk patients.

Acute Diagnosis and Management of Stroke Presenting Dizziness or Vertigo

“…6 However, ED patients with dizziness/vertigo had a twofold higher risk of stroke or cardiovascular events than those without during a follow-up of 3 years. 7 Furthermore, those who had been hospitalized with isolated vertigo had a threefold higher risk for stroke than the general population during the 4-year follow-up. 8 Particularly, the patients with 3 or more risk factors had a 5.5-fold higher risk for stroke than those without risk factors.…”

A New Diagnostic Approach to the Adult Patient with Acute Dizziness

“…Posterior circulation location is a risk factor for stroke misdiagnosis in general (31,36–38). To put these data into context, only a very small proportion (0.18–0.7%) of ED patients diagnosed with a benign or peripheral vestibular diagnosis return to the ED within 30 days and are hospitalized with a cerebrovascular diagnosis (38–41). However, because dizziness is so common, this very small percentage probably translates into tens of thousands of missed strokes and likely thousands of patients harmed each year (42).…”

Isolated vestibular syndromes due to brainstem and cerebellar lesions

“…In patients with vertigo due to vertebrobasilar infarction, 62% had at least one episode of isolated vertigo and 19% developed vertigo as the initial symptom [3]. Patients with dizziness/vertigo had twofold higher risk of stroke or cardiovascular events than those without dizziness/vertigo during a follow-up of 3 years [4]. Recognition of cerebral ischemia as a cause of AVS is important since isolated vascular vertigo requires a prompt evaluation of the cerebral vasculature and proper therapy for prevention of progression into more extensive infarction involving the posterior circulation [5].…”