Predictive model for diagnosing central lesions in emergency department patients with isolated dizziness who undergo diffusion‐weighted magnetic resonance imaging

Abstract

Objectives Only 5% to 10% of patients who visit the emergency department (ED) with isolated dizziness without neurologic abnormalities may have central lesions; however, it is important to distinguish central lesions through brain imaging. This study was conducted to create a nomogram to provide an objective medical basis for selectively performing magnetic resonance imaging (MRI) among patients with isolated dizziness. Methods This retrospective observational study enrolled patients who visited the ED of a tertiary hospital with isolated dizziness and underwent diffusion‐weighted MRI and subsequently consulted with the departments of neurology, neurosurgery, or otorhinolaryngology. Multivariable logistic regression analysis was performed to identify risk factors in patients diagnosed with central lesions to create a nomogram with the significant variables. Results Of the 1,078 patients who were screened, 119 were diagnosed with central lesions. Significant variables in the multivariable logistic regression analysis were albumin levels (odds ratio [OR] = 0.339, 95% confidence interval [CI] = 0.188 to 0.610, p = 0.0003), inorganic phosphate levels (OR = 0.891, 95% CI = 0.832 to 0.954, p = 0.0010), history of ischemic stroke (OR = 3.170, 95% CI = 1.807 to 5.560, p < 0.0001), presyncope (OR = 3.152, 95% CI = 1.184 to 8.389, p = 0.0216), and nystagmus (OR = 0.365, 95% CI = 0.237 to 0.561, p < 0.0001). The area under the receiver operating characteristic curve of the nomogram created with these variables was 0.7315 (95% CI = 0.6842 to 0.7788, p < 0.0001). Conclusions Albumin, inorganic phosphate, previous stroke, presyncope, and nystagmus were associated with the predictive diagnosis of central lesions among patients admitted to the ED with isolated dizziness. The novel nomogram created using these variables can help in objectively determining the need for MRI in patients presenting with isolated dizziness to the ED.

Blood biomarkers for the differentiation between central and peripheral vertigo in the emergency department: a systematic review and meta‐analysis

“…The literature search identified a total of 7282 articles that were screened for eligibility. Of these studies, 23 articles were further assessed for eligibility, where a total of 20 studies were included for analysis 19,20,25–42 . One study was not included in the final analysis due to missing patient data, despite multiple attempts to contact the author 42 .…”

“…Biomarkers analyzed in single studies that were able to differentiate between central and peripheral causes of AVS include: neutrophil percent ( p < 0.001), 20 thrombotic microangiopathy score (TMA; p = 0.016), 28 adiponectin ( p < 0.001), 38 alkaline phosphatase (ALP; p = 0.021), 28 fibrinogen ( p < 0.001), 40 high‐sensitivity C‐reactive protein (hs‐CRP; p < 0.001), 20 inorganic phosphorus ( p = 0.007), 28 magnesium (2 + ; p = 0.003), 28 miR‐125a‐5p ( p = 0.001), 32 miR‐125b‐5p ( p < 0.001), 32 miR‐143‐3p ( p = 0.014), 32 miR‐433‐5p ( p = 0.006), 32 and total protein ( p = 0.038 28 ; Tables S1–S3). Single‐study analyzed biomarkers that were not able to differentiate central from peripheral causes include: delta neutrophil index ( p = 0.945), 28 erythrocyte sedimentation rate ( p = 0.065), 20 platelet‐to‐lymphocyte ratio ( p = 0.306), 41 prothrombin time ( p = 0.68), 34 ammonia ( p = 0.459), 28 aspartate aminotransferase (AST; p = 0.603), 28 alanine transaminase ( p = 0.643), 28 ionized calcium ( p = 0.243), 28 creatinine kinase ( p = 0.35), 34 lactate dehydrogenase ( p = 0.47), 19 BDNF ( p > 0.05), 39 GFAP ( p > 0.05), 39 interleukin‐6 ( p > 0.05), 39 MMP‐9 ( p = 0.102), 37 soluble vascular cellular adhesion molecule‐1 ( p = 0.524), 38 miR‐342‐3p ( p = 0.81), 32 miR‐376a‐3p ( p = 0.056), 32 high‐density lipoprotein cholesterol ( p = 0.269), 37 myoglobin ( p = 0.45), 34 total bilirubin ( p = 0.430), 28 total cholesterol ( p = 0.185), 38 triglycerides ( p = 0.336), 38 troponin I ( p = 0.90), 35 urea ( p = 0.230), 31 and uric acid ( p = 0.239 28 ; Tables S1–S3).…”

“…Of these studies, 23 articles were further assessed for eligibility, where a total of 20 studies were included for analysis. 19,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] One study was not included in the final analysis due to missing patient data, despite multiple attempts to contact the author. 42 After risk-of-bias analysis (Table 1), an additional two studies were excluded due to high risk of bias, where a total of 17 studies were included in our review and meta-analysis.…”

“…Tables S1-S3). Chang 2011 26 Deboevere 2019 27 Han 2021 28 Hong 2021 29 Jo 2019 30 Kartal 2014 31 Kijpaisalratana 2020 32 Kim 2021 19 Koyuncu 2021 33 Lee 2018 34 Lin 2019 20 Masoumi 2022 35 Mozafari 2020 36 Purrucker 2014 37 Qian 2022 38 Sohn 2020 39 Wang 2021 40 Zhang 2019 41 Zuo 2018 42 Note: high; unclear; low.…”