title: The TriAGe+ Score for Vertigo or Dizziness: A Diagnostic Model for Stroke in the Emergency Department.
abstract: BACKGROUND
  Vertigo or dizziness is a common occurrence, but it remains a challenging symptom when encountered in the emergency department (ED). A diagnostic score for stroke with high accuracy is therefore required.
  
  
  METHODS
  A single-center observational study (498 patients) was conducted. The predictor variables were derived from a multivariate logistic regression analysis with Akaike information criterion. The outcome was the occurrence of stroke. We evaluated the utility of a new diagnostic score (TriAGe+) and compared it with the ABCD2 score.
  
  
  RESULTS
  The cohorts included 498 patients (147 with stroke [29.4%]). Eight variables were included: triggers, atrial fibrillation, male gender, blood pressure ≥140/90 mm Hg, brainstem or cerebellar dysfunction, focal weakness or speech impairment, dizziness, and no history of vertigo or dizziness or labyrinth or vestibular disease. We derived the TriAGe+ score from these variables. In the cohort, the prevalence of stroke increased significantly using the diagnostic score: 5.9% for a score of 0-4; 9.1% for 5-7; 24.7% for 8-9; and 57.3% for 10-17. At a cutoff value of 10 points, the sensitivity of the score was 77.5%, the specificity was 72.1%, and the positive likelihood ratio was 3.2. When the cutoff was defined as 5 points, the score obtained a high sensitivity (96.6%) with a good negative likelihood ratio (.15). The new score outperformed the ABCD2 score for the occurrence of stroke (C statistic, .818 versus .726; P < .001).
  
  
  CONCLUSIONS
  The TriAGe+ score can identify the occurrence of stroke in patients with vertigo or dizziness presenting to the ED.
authors.affiliation: Department of Neurology, Hamamatsu University School of Medicine, Shizuoka, Japan. Electronic address: ryokrd@hama-med.ac.jp.
authors.forename: R
authors.initials: R
authors.lastname: Kuroda
authors.affiliation: Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakada
authors.affiliation: Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ojima
authors.affiliation: Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Serizawa
authors.affiliation: Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Imai
authors.affiliation: Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Yagi
authors.affiliation: Departments of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Tasaki
authors.affiliation: Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Aoki
authors.affiliation: Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Oiwa
authors.affiliation: Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ogane
authors.affiliation: Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Mochizuki
authors.affiliation: Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kobari
authors.affiliation: Department of Neurology, Hamamatsu University School of Medicine, Shizuoka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyajima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003661:Decision Support Techniques; D004244:Dizziness / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D014218:Triage / Q000379:methods*; D014717:Vertigo / Q000453:epidemiology*
keywords: ABCD2; Vertigo; diagnosis; dizziness; emergency departments; stroke