Missed strokes using computed tomography imaging in patients with vertigo: population-based cohort study

Area of Science:

• Emergency Medicine
• Neurology
• Radiology

Background:

• Peripheral vertigo is a common emergency department (ED) diagnosis.
• Computed tomography (CT) head imaging is often utilized for these patients, despite not being recommended by current guidelines.
• The diagnostic yield and potential risks of CT head imaging in this population are not well understood.

Purpose of the Study:

• To determine the proportion of ED patients diagnosed with peripheral vertigo who undergo CT head imaging.
• To investigate whether CT head imaging is associated with missed strokes in this patient group.

Main Methods:

• A population-based retrospective cohort study was conducted in Ontario, Canada, from April 2006 to March 2011.
• Patients diagnosed with peripheral vertigo were identified, and those who received CT head imaging (exposed) were matched to those who did not (unexposed) using propensity score methods.
• The incidence of stroke within 30, 90, and 365 days post-discharge was compared between the exposed and unexposed groups.

Main Results:

• Out of 41,794 qualifying patients, 20.6% received ED head CT imaging.
• The rate of hospitalization for stroke within 30 days was higher in the exposed group (0.29%) compared to the unexposed group (0.13%).
• The relative risk of stroke at 30 and 90 days was significantly higher for patients who received CT imaging.

Conclusions:

• A substantial proportion of patients diagnosed with peripheral vertigo in the ED receive non-guideline-recommended CT head imaging.
• This imaging is associated with an increased risk of missed early strokes.
• Adherence to clinical guidelines for peripheral vertigo diagnosis and management should be reinforced to avoid unnecessary imaging and potential adverse outcomes.