title: Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department.
abstract: OBJECTIVE
  Dizziness can herald a cerebrovascular event. The ABCD(2) score predicts the risk of stroke after transient ischemic attack partly by distinguishing transient ischemic attack from mimics. We evaluated whether this score would also identify cerebrovascular events among emergency department patients with dizziness.
  
  
  METHODS
  We retrospectively identified consecutive adults presenting to a university emergency department with a primary symptom of dizziness, vertigo, or imbalance. Two neurologists independently reviewed medical records to determine whether the presenting symptom was caused by a cerebrovascular event (ischemic stroke, transient ischemic attack, or intracranial hemorrhage). ABCD(2) scores were then assigned using clinical information from the medical record. The ability of the score to discriminate between patients with cerebrovascular events and those with other diagnoses was quantified using the c statistic.
  
  
  RESULTS
  Among 907 dizzy patients (mean age, 59 years; 58% female), 37 (4.1%) had a cerebrovascular cause, the majority of which were ischemic strokes (n=24). The median ABCD(2) score was 3 (interquartile range, 3-4). The ABCD(2) score predicted ultimate diagnosis of a cerebrovascular event (c statistic, 0.79; 95% CI, 0.73-0.85). Only 5 of 512 (1.0%) patients with a score of ≤ 3 had a cerebrovascular event compared to 25 of 369 patients (6.8%) with a score of 4 or 5 and 7 of 26 patients (27.0%) with a score of 6 or 7.
  
  
  CONCLUSIONS
  The ABCD(2) score may provide useful information on dizzy emergency department patients at low-risk for having a cerebrovascular diagnosis and may aid frontline providers in acute management if validated prospectively.
authors.affiliation: Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Babak B
authors.initials: BB
authors.lastname: Navi
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.forename: Maulik P
authors.initials: MP
authors.lastname: Shah
authors.forename: Aaron W
authors.initials: AW
authors.lastname: Grossman
authors.forename: Christine
authors.initials: C
authors.lastname: Wong
authors.forename: Sharon N
authors.initials: SN
authors.lastname: Poisson
authors.forename: William D
authors.initials: WD
authors.lastname: Whetstone
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D004244:Dizziness / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology