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Predictors of vertigo in the emergency department: The preved study.

Publication ,  Journal Article
Mandge, V; Palaiodimos, L; Lai, Q; Papanastasiou, CA; Wang, Y; Santos, D; Grau, L; Kodali, A; Ocava, L; Gutwein, AH
Published in: J Stroke Cerebrovasc Dis
September 2020

BACKGROUND AND PURPOSE: Acute vertigo (sense of motion) can be the sole manifestation of a posterior circulation stroke, and often gets missed in the emergency department (ED). The studies for evaluation of central vertigo have focused on physical exam findings, which require expertise and may not be suitable for rapid triage by a nurse in ED or by paramedics. METHODS: This cross sectional study included retrospective chart review of patients 18 years of age and older who presented to the Adult ED with acute dizziness or vertigo during the calendar year 2017. All the patients with a diagnosis of central or peripheral vertigo were included in the final analysis. Sensitivity, specificity, Likelihood Ratio of positive result (LR (+)) and Likelihood Ratio of negative result (LR (-)) for central and peripheral vertigo were calculated for risk factors, symptoms and physical examination features. Chi-squared test and univariate logistic regression were used to evaluate statistical correlation and to calculate the prevalence odds ratio (POR). RESULTS: Two hundred and forty nine out of 505 (49.3%) patients presenting with dizziness had vertigo. Of these, 14 had central vertigo and 163 had peripheral vertigo. Statistically significant variables were: constant symptoms of vertigo (p 0.000- POR 8.7, 95% confidence interval (CI) 2.3-33.1), no change in symptoms with head movement (p 0.000- POR 10.2, 95% CI 3.0-35.4), dysmetria (p 0.000- POR 56.8, 95% CI 5.8-557.1), and unsteady gait (p 0.000- POR 13.3, 95% CI 3.3-54.3). The sensitivity and specificity to detect central vertigo were 100% and 66.4% respectively if the patient had either unsteady gait, constant symptoms, or no change in symptoms with head movement, [VAIN triad (Vertigo- Ataxia, Incessant, or Non-positional)]. CONCLUSIONS: We suggest that triage with VAIN triad can be used to design prospective studies to develop a triage algorithm for the detection of central vertigo in the ED.

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Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

September 2020

Volume

29

Issue

9

Start / End Page

105043

Location

United States

Related Subject Headings

  • Vertigo
  • Triage
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Reproducibility of Results
  • Prognosis
  • Predictive Value of Tests
  • Postural Balance
  • Neurology & Neurosurgery
 

Citation

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Mandge, V., Palaiodimos, L., Lai, Q., Papanastasiou, C. A., Wang, Y., Santos, D., … Gutwein, A. H. (2020). Predictors of vertigo in the emergency department: The preved study. J Stroke Cerebrovasc Dis, 29(9), 105043. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105043
Mandge, Vishal, Leonidas Palaiodimos, Qingying Lai, Christos A. Papanastasiou, Yanjun Wang, Daniel Santos, Luis Grau, Alimitha Kodali, Lenore Ocava, and Andrew H. Gutwein. “Predictors of vertigo in the emergency department: The preved study.J Stroke Cerebrovasc Dis 29, no. 9 (September 2020): 105043. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105043.
Mandge V, Palaiodimos L, Lai Q, Papanastasiou CA, Wang Y, Santos D, et al. Predictors of vertigo in the emergency department: The preved study. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105043.
Mandge, Vishal, et al. “Predictors of vertigo in the emergency department: The preved study.J Stroke Cerebrovasc Dis, vol. 29, no. 9, Sept. 2020, p. 105043. Pubmed, doi:10.1016/j.jstrokecerebrovasdis.2020.105043.
Mandge V, Palaiodimos L, Lai Q, Papanastasiou CA, Wang Y, Santos D, Grau L, Kodali A, Ocava L, Gutwein AH. Predictors of vertigo in the emergency department: The preved study. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105043.
Journal cover image

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

September 2020

Volume

29

Issue

9

Start / End Page

105043

Location

United States

Related Subject Headings

  • Vertigo
  • Triage
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Reproducibility of Results
  • Prognosis
  • Predictive Value of Tests
  • Postural Balance
  • Neurology & Neurosurgery