Predictors of important neurological causes of dizziness among patients presenting to the emergency department

Abstract

Most dizzy patients had benign causes. Several clinical factors favoured a diagnosis of central neurological causes of dizziness.

Rate and Predictors of Serious Neurologic Causes of Dizziness in the Emergency Department

“…Based on the results of previous studies and expected rates of outcomes, the following clinical factors were chosen a priori as potential predictors of outcomes: age, imbalance as the reference triage symptom, isolated dizziness symptoms (eg, no other associated neurologic or systemic symptoms), positional symptoms, previous stroke, diabetes mellitus, Dix-Hallpike maneuver, and focal examination abnormalities (any neurologic sign besides nystagmus). [6][7][8]10,13 Logistic regression was used to evaluate the association between these prespecified factors and the primary outcome. Of these 8 prespecified factors, those that were significantly (PϽ.10) associated with the outcome in univariate analysis (age, imbalance as the triage symptom, isolated dizziness, previous stroke, and focal examination abnormalities) were forced into the final multivariate model.…”

“…14 Our results are also consistent with those of previous studies, which found low rates of serious neurologic diagnoses in ED patients with dizziness. 3,[6][7][8][9][10]13 A prospective analysis of 413 adults with dizziness presenting to a Hong Kong ED found a central neurologic cause in 6% of patients, although this study may have underestimated the number of patients with posterior fossa lesions since diagnoses were made using CT only. 10 Similarly, a population-based study of 1666 mostly Mexican American patients presenting with dizziness to EDs in Corpus Christi, Texas, demonstrated an incidence of stroke or TIA of 3.2% (this study assessed for acute cerebrovascular disorders only).…”

“…3,[6][7][8][9][10]13 A prospective analysis of 413 adults with dizziness presenting to a Hong Kong ED found a central neurologic cause in 6% of patients, although this study may have underestimated the number of patients with posterior fossa lesions since diagnoses were made using CT only. 10 Similarly, a population-based study of 1666 mostly Mexican American patients presenting with dizziness to EDs in Corpus Christi, Texas, demonstrated an incidence of stroke or TIA of 3.2% (this study assessed for acute cerebrovascular disorders only). 7 In addition, a meta-analysis of relevant studies published between 1966 and 1996 reported a 6% frequency of central neurologic diseases in ED patients with dizziness, most of which were cerebrovascular in origin.…”

“…4,5 Previous studies have found that acute dizziness is most often caused by benign conditions, such as peripheral vertigo, orthostatic hypotension, and psychogenic disorders, whereas serious neurologic conditions, such as stroke and brain tumors, are rare. [6][7][8][9][10] However, dizziness due to serious neurologic disease could be underestimated because most previous studies took place before the advent of modern diagnostic neuroimaging or did not include detailed medical record review by a neurologist. 6,[8][9][10] Furthermore, many previous analyses were limited by small sample sizes or by the inclusion of patients with chronic dizziness in ambulatory care settings or were larger studies that used national administrative databases that were valuable in measuring the impact of dizziness presentations on EDs but were limited by a lack of available clinical detail.…”

“…[6][7][8][9][10] However, dizziness due to serious neurologic disease could be underestimated because most previous studies took place before the advent of modern diagnostic neuroimaging or did not include detailed medical record review by a neurologist. 6,[8][9][10] Furthermore, many previous analyses were limited by small sample sizes or by the inclusion of patients with chronic dizziness in ambulatory care settings or were larger studies that used national administrative databases that were valuable in measuring the impact of dizziness presentations on EDs but were limited by a lack of available clinical detail. 2,3,6,8,9,11 Therefore, the magnitude of the risk of serious causes of acute dizziness in the ED and the question of which clinical variables predict central nervous system disease remain poorly understood.…”