Year: 2015
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations. METHODS: Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD(2) score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low (<5%), intermediate (5% to <10%), and high (≥10%) predicted probability risk categories. RESULTS: Acute stroke was identified in 29 of 272 patients (10.7%). Associations with stroke were as follows: ABCD(2) score (continuous) (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.20-2.51), any other CNS features (OR 2.54; 95% CI 1.06-6.08), OM assessment (OR 2.82; 95% CI 0.96-8.30), and prior stroke (OR 0.48; 95% CI 0.05-4.57). No stroke cases were in the model's low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%). CONCLUSION: In acute dizziness presentations, the combination of ABCD(2) score, general neurologic examination, and a specialized OM examination has the capacity to risk-stratify acute stroke on MRI.
Source: Neurology
Institutions: University of Michigan, Michigan Medicine
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: bronze
Funders: Agency for Healthcare Research and Quality, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Institute on Minority Health and Health Disparities
Awards: Using Outcomes Analyses to Inform Implementation of NINDS Clinical Trials, AVERT_Acute Video-oculography for Vertigo in Emergency Rooms for Rapid Triage, University of Michigan Regional Coordinating Stroke Center, Sleep apnea health disparities in Mexican American stroke patients, Reducing Racial Disparities in Post-Stroke Disability in the Elderly, SOLUTIONS FOR VERTIGO PRESENTATIONS IN THE EMERGENCY DEPARTMENT (SOLVE) PROJECT, SELF-DIAGNOSIS AND TREATMENT TOOLS FOR BENIGN PAROXYSMAL POSITIONAL VERTIGO, DIZZiness Treatment through ImplementatioN & Clinical strategy Tactics (DIZZTINCT-2) Project, The Challenge of Individualizing Treatments for Patients with Breast Cancer, POINT: PLATELET-ORIENTED INHIBITION IN NEW TIA, IMPACT OF CMS HOSPITAL-ACQUIRED CONDITIONS ON VULNERABLE PATIENTS AND HOSPITALS, Stroke Health and Risk Education (SHARE), Dizziness in the Emergency Department: A Population-Based Project, Michigan Center for Diabetes Translational Research
OpenAlex ID: W2174393744