title: ED patients with vertigo: can we identify clinical factors associated with acute stroke?
abstract: BACKGROUND
  Vertigo is a common emergency department (ED) complaint with benign and serious etiologies with overlapping features. Misdiagnosis of acute stroke may result in significant morbidity and mortality. Magnetic resonance imaging (MRI) is superior to computer tomography (CT) for diagnosis of acute stroke but is costly with limited availability.
  
  
  OBJECTIVE
  The aim of this study was to identify clinical characteristics associated with a cerebrovascular cause for vertigo.
  
  
  METHODS
  We performed a retrospective chart review on patients with an MRI for vertigo, with or without additional historical or physical examination findings, over 18 months. Study patients were seen in the ED for vertigo within 2 weeks of MRI. Data collected included medical history, physical findings, and imaging results. Fisher's exact test was used to identify factors associated with the primary outcome, an acute stroke.
  
  
  RESULTS
  There were 325 eligible patients; 131 were ED patients. Patients were 57 (± 18) years, and 53% were women. There were 12 ED patients with a new stroke (9.2%). Two variables were associated with acute stroke: a presenting complaint of gait instability (odds ratio, 9.3; 95% confidence interval, 2.6-33.9) or a subtle neurologic finding (odds ratio, 8.7; 95% confidence interval, 2.3-33.1). One patient with a new stroke had a prior stroke, 3 were age >65 years, and none had coronary artery disease or dysrhythmia. Among patients with acute stroke, 5 also had head CT, and none detected the stroke.
  
  
  CONCLUSIONS
  This study identified 2 variables associated with acute stroke that should be considered in the evaluation of ED patients with vertigo. Head CT was inadequate for diagnosing acute stroke in this patient population.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, One Deaconess Road, West, Clinical Center 2, Boston, MA 02215, USA. Mchase1@bidmc.harvard.edu
authors.forename: Maureen
authors.initials: M
authors.lastname: Chase
authors.forename: Nina R
authors.initials: NR
authors.lastname: Joyce
authors.forename: Erin
authors.initials: E
authors.lastname: Carney
authors.forename: Justin D
authors.initials: JD
authors.lastname: Salciccioli
authors.forename: Deborah
authors.initials: D
authors.lastname: Vinton
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D016017:Odds Ratio; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014717:Vertigo / Q000209:etiology*