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

• Published in: Mayo Clinic proceedings Vol. 87; no. 11; pp. 1080 - 1088
• Main Authors: Navi, Babak B., MD, Kamel, Hooman, MD, Shah, Maulik P., MD, Grossman, Aaron W., MD, PhD, Wong, Christine, MD, Poisson, Sharon N., MD, MAS, Whetstone, William D., MD, Josephson, S. Andrew, MD, Johnston, S. Claiborne, MD, PhD, Kim, Anthony S., MD, MAS
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01-11-2012; Mayo Foundation; Elsevier, Inc; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Brain Ischemia - diagnosis; Brain Ischemia - epidemiology; Care and treatment; Central Nervous System Diseases - diagnosis; Central Nervous System Diseases - epidemiology; Comorbidity; Confidence Intervals; Diagnosis; Dizziness; Dizziness - diagnosis; Dizziness - epidemiology; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Emergency Medicine - statistics & numerical data; Emergency Service, Hospital; Female; General aspects; Humans; Internal Medicine; Male; Medical History Taking - statistics & numerical data; Medical sciences; Methods; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neuroimaging; Neurology; Non tumoral diseases; Odds Ratio; Original; Otorhinolaryngology. Stomatology; Prevalence; Retrospective Studies; Risk factors; Stroke - diagnosis; Stroke - epidemiology; Young Adult; United States; computed tomography; CT; magnetic resonance imaging; MRI; transient ischemic attack; emergency department; TIA; ED; Equilibrium disorder; Medicine; Nervous system diseases; Emergency department; Rate; Cause; Prediction; ENT disease; Predictive factor; Vertigo
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2012.05.023

Abstract Objective To describe the rate and predictors of central nervous system (CNS) disease in emergency department (ED) patients with dizziness in the modern era of neuroimaging. Patients and Methods We retrospectively reviewed the medical records of all adults presenting between January 1, 2007, and December 31, 2009, to an academic ED for a primary triage complaint of dizziness, vertigo, or imbalance. The final diagnosis for the cause of dizziness was independently assigned by 2 neurologists, with a third neurologist resolving any disagreements. The primary outcome was a composite of ischemic stroke, intracranial hemorrhage, transient ischemic attack, seizure, brain tumor, demyelinating disease, and CNS infection. Univariate and multivariate logistic regression were used to assess the association between clinical variables and serious CNS causes of dizziness. Results Of 907 patients experiencing dizziness (mean age, 59 years; 58% women [n=529]), 49 (5%) had a serious neurologic diagnosis, including 37 cerebrovascular events. Dizziness was often caused by benign conditions, such as peripheral vertigo (294 patients [32%]) or orthostatic hypotension (121 patients [13%]). Age 60 years or older (odds ratio [OR], 5.7; 95% confidence interval [CI], 2.5-11.2), a chief complaint of imbalance (OR, 5.9; 95% CI, 2.3-15.2), and any focal examination abnormality (OR, 5.9; 95% CI, 3.1-11.2) were independently associated with serious neurologic diagnoses, whereas isolated dizziness symptoms were inversely associated (OR, 0.2; 95% CI, 0.0-0.7). Conclusion Dizziness in the ED is generally benign, although a substantial fraction of patients harbor serious neurologic disease. Clinical suspicion should be heightened for patients with advanced age, imbalance, or focal deficits.