title: A prospective pilot study of predictors of acute stroke in emergency department patients with dizziness.
abstract: OBJECTIVE
  To prospectively examine undifferentiated emergency department (ED) patients with dizziness to identify clinical features associated with acute stroke.
  
  
  METHODS
  We conducted a pilot study from November 1, 2009, through October 30, 2010, of adult patients with dizziness presenting to 3 urban academic EDs. Data collected included demographic characteristics, medical history, presenting symptoms, examination findings, clinician pretest probability of stroke, and neuroimaging results. Logistic regression was used to identify variables with a significant association with acute stroke (P<.05).
  
  
  RESULTS
  During the study period, we enrolled 473 patients (mean ± SD age, 56.7±19.3 years; 60% female; and 71% white). We found 30 acute, serious diagnoses (6.3%), including 14 ischemic strokes, 2 subarachnoid hemorrhages, 7 mass lesions, 2 demyelinating lesions, 2 severe vertebral artery stenoses, 2 acute coronary syndromes, and 1 case of hydrocephalus and meningitis). We identified 6 clinical variables associated with stroke: age (odds ratio [OR], 1.04; 95% CI, 1.0-1.07), hyperlipidemia (OR, 3.62; 95% CI, 1.24-10.6), hypertension (OR, 4.91; 95% CI, 1.46-16.5), coronary artery disease (OR, 3.33; 95% CI, 1.06-10.5), abnormal tandem gait test result (OR, 3.13; 95% CI, 1.10-8.89), and high or moderate physician pretest probability for acute stroke (OR, 18.8; 95% CI, 4.72-74.5).
  
  
  CONCLUSIONS
  Most ED patients with dizziness do not have a serious cause of their symptoms. Although the small number of outcomes precluded development of a multivariate model, we identified several individual high-risk variables associated with acute ischemic stroke. Further study will be needed to validate the findings of this pilot investigation.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mchase1@bidmc.harvard.edu.
authors.forename: Maureen
authors.initials: M
authors.lastname: Chase
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Magdy H
authors.initials: MH
authors.lastname: Selim
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Camacho
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: O'Connor
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
mesh_terms: D003937:Diagnosis, Differential; D004244:Dizziness / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis*
keywords: ED; OR; emergency department; odds ratio