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Stroke risk after nonstroke emergency department dizziness presentations: a population-based cohort study
Kevin A Kerber1, Darin B Zahuranec, Devin L Brown
1Department of Neurology University of Michigan Health System, Ann Arbor, MI; Stroke Program, University of Michigan Health System, Ann Arbor, MI.
Annals of Neurology
|May 3, 2014
Summary
The risk of stroke after emergency department dizziness is very low, with only 1.2% of patients experiencing a stroke. Most strokes occurred within two days, indicating a need for better risk stratification for high-risk individuals.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Acute stroke is a critical concern in emergency department (ED) dizziness presentations.
- Previous research suggests stroke is an unlikely cause of these presentations.
- Population-based data on short- and long-term stroke risk after presumed non-stroke ED dizziness is lacking.
Purpose of the Study:
- To establish the population-based stroke risk after presumed non-stroke emergency department (ED) dizziness presentations.
- To assess short- and long-term follow-up data for stroke events in this patient group.
Main Methods:
- A population-based cohort of patients aged 45 years and older presenting with dizziness, vertigo, or imbalance to EDs in Nueces County, Texas, was identified from May 2011 to May 2012.
- Patients with an initial stroke diagnosis were excluded.
- Stroke events were tracked up to October 2012 using the Brain Attack Surveillance in Corpus Christi (BASIC) study, with neurologist validation.
Main Results:
- A total of 1,245 patients were followed for a median of 347 days.
- Fifteen patients (1.2%) experienced a stroke after their ED visit.
- The cumulative stroke risk was 0.48% at 2 days, 0.56% at 30 days, and 1.42% at 12 months.
Conclusions:
- The risk of stroke following presumed non-stroke ED dizziness presentations is very low.
- This supports a non-stroke etiology for the majority of initial dizziness events.
- High-risk subgroups may exist, as most 90-day stroke risk occurred within 2 days, and current vascular risk stratification was insufficient for identification.
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