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2016 ; 16
(1
): 37
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Keep it simple: vascular risk factors and focal exam findings correctly identify
posterior circulation ischemia in "dizzy" patients
#MMPMID27619651
Chen K
; Schneider AL
; Llinas RH
; Marsh EB
BMC Emerg Med
2016[Sep]; 16
(1
): 37
PMID27619651
show ga
BACKGROUND: Dizziness is a common chief complaint of patients presenting to the
Emergency Department (ED). Physicians must quickly and accurately identify
patients whose etiology is most likely ischemia. Additional tools are available,
but often require further training (vestibular testing) or are costly and not
always readily available (magnetic resonance imaging (MRI)). This study evaluates
the ability of a routine history and simple physical examination to correctly
identify dizzy patients with posterior circulation ischemia, and the added
utility of CT angiography (CTA). METHODS: We performed a retrospective analysis
of all individuals presenting to the ED with a reported chief complaint of
dizziness. Neurology was consulted and CTA ordered at the discretion of the ED
provider. Demographic, medical, and radiographic variables were evaluated along
with final diagnosis. Multivariable logistic regression and ROC analysis were
used to determine factors associated with ischemia, the sensitivity of vascular
risk factors and focal exam findings in predicting ischemia, and the additional
benefit, if any, of CTA. RESULTS: One thousand two-hundred sixteen individuals
meeting inclusion criteria presented to the ED over a 2 year period and were
included in analysis. One hundred (8.2 %) were diagnosed with posterior
circulation ischemia. For the entire cohort, age (OR 1.4 per 10 years,
p?0.0001), systolic blood pressure (OR 1.3 per 10 mmHg, p?0.0001), and focal
exam findings (OR 28.69, p?0.0001) were most significantly associated with
ischemia in multivariable modeling. When age, race, sex, presence of vascular
risk factors, and focal neurologic findings were entered into ROC analysis, the
AUC for correctly identifying posterior circulation ischemia was 0.90. In the
subset of patients who underwent CTA (n?=?87), the AUC did not improve (0.78 with
and without CTA in ROC analysis, p?=?0.52). CONCLUSIONS: A vascular risk
assessment and neurological examination are adequate for risk stratification of
ischemia in the dizzy patient and should remain the standard evaluation.