R Kuroda1, T Nakada2, T Ojima3, M Serizawa4, N Imai4, N Yagi4, A Tasaki5, M Aoki2, T Oiwa2, T Ogane2, K Mochizuki2, M Kobari4, H Miyajima6. 1. Department of Neurology, Hamamatsu University School of Medicine, Shizuoka, Japan. Electronic address: ryokrd@hama-med.ac.jp. 2. Critical Care Medical Center, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan. 3. Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan. 4. Department of Neurology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan. 5. Departments of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan. 6. Department of Neurology, Hamamatsu University School of Medicine, Shizuoka, Japan.
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.
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: C Magnusson; J Gärskog; E Lökholm; J Stenström; R Wetter; C Axelsson; M Andersson Hagiwara; N Packendorff; K Jood; T Karlsson; J Herlitz Journal: BMC Emerg Med Date: 2021-03-25
Authors: Bum Joon Kim; Su-Kyeong Jang; Yong-Hwan Kim; Eun-Jae Lee; Jun Young Chang; Sun U Kwon; Jong S Kim; Dong-Wha Kang Journal: Front Neurol Date: 2021-07-12 Impact factor: 4.003