Rate and predictors of serious neurologic causes of dizziness in the emergency department.
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.


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).


CONCLUSIONS
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.
Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY, USA.
Babak B
BB
Navi
Hooman
H
Kamel
Maulik P
MP
Shah
Aaron W
AW
Grossman
Christine
C
Wong
Sharon N
SN
Poisson
William D
WD
Whetstone
S Andrew
SA
Josephson
S Claiborne
SC
Johnston
Anthony S
AS
Kim
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D016001:Confidence Intervals; D004244:Dizziness / Q000175:diagnosis* / Q000453:epidemiology*; D004635:Emergency Medicine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult