Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department - 01/08/24

Doi : 10.1016/j.annemergmed.2024.06.003

Robert Ohle, MSc, MBBCh ^a,^⁎ , David W. Savage, MD, PhD ^b, Danielle Roy, BSc ^c, Sarah McIsaac, Med, MBBCh ^d, Ravinder Singh, MD ^e, Daniel Lelli, MD ^f, Darren Tse, MD ^f, Peter Johns, MD ^g, Krishan Yadav, MSc, MD ^g, Jeffrey J. Perry, MSc, MD ^g
^a Department of Emergency Medicine, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
^b Department of Emergency Medicine, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
^c School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
^d Department of Critical Care, Department of Anesthesia, Northern Ontario School of Medicine, Sudbury, ON, Canada
^e Department of Neurology, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada
^f Department of Neurology and Otolaryngology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
^g Department of Emergency Medicine University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 01 August 2024

Abstract

Study objective

Identify high-risk clinical characteristics for a serious cause of vertigo in patients presenting to the emergency department (ED).

Methods

Multicentre prospective cohort study over 3 years at three university-affiliated tertiary care EDs. Participants were patients presenting with vertigo, dizziness or imbalance. Main outcome measurement was an adjudicated serious diagnosis defined as stroke, transient ischemic attack, vertebral artery dissection or brain tumour.

Results

A total of 2,078 of 2,618 potentially eligible patients (79.4%) were enrolled (mean age 77.1 years; 59% women). Serious events occurred in 111 (5.3%) patients. We used logistic regression to create a 7-item prediction model: male, age over 65, hypertension, diabetes, motor/sensory deficits, cerebellar signs/symptoms and benign paroxysmal positional vertigo diagnosis (C-statistic 0.96, 95% confidence interval [CI] 0.92 to 0.98). The risk of a serious diagnosis ranged from 0% for a score of <5, 2.1% for a score of 5 to 8, and 41% for a score >8. Sensitivity for a serious diagnosis was 100% (95% CI, 97.1% to 100%) and specificity 72.1% (95% CI, 70.1% to 74%) for a score <5.

Conclusion

The Sudbury Vertigo Risk Score identifies the risk of a serious diagnosis as a cause of a patient’s vertigo and if validated could assist physicians in guiding further investigation, consultation, and treatment decisions, improving resource utilization and reducing missed diagnoses.

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Plan

Clinical Implications

Strengths

	Supervising editor: Clifton Callaway, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: Danielle Roy performed the analysis, provided methodology input, and manuscript contributions. Dr. Ohle was responsible for study design, oversight and manuscript preparation. Dr. Perry provided methodology input in addition to manuscript preparation. Dr. Savage and Dr. Yadav provided methodology input. Dr. McIsaac provided methodology input and oversight in addition to manuscript editing. Drs. Singh, Lelli, Tse and Johns were content experts and provided study design input in addition to manuscript preperation. Dr. Ohle acts as guarantor for accuracy and integrity of the manuscript as a whole.
	Data sharing statement: Deidentified participant data, data dictionary, and analytic code will be available upon reasonable request to the corresponding author (robert.ohle@gmail.com) upon manuscript publication.
	Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was supported through grants from the Northern Ontario Academic Medical Association and Physician Services Incorporated Foundation. The authors have no conflict of interest relevant to this article to disclose.
	Please see page XX for the Editor’s Capsule Summary of this article.