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The TriAGe+ Score for Vertigo or Dizziness: A Diagnostic Model for Stroke in the Emergency Department
Insights
A new diagnostic score, TriAGe+, accurately identifies stroke in patients with vertigo or dizziness in the emergency department. This score outperforms the ABCD2 score, improving stroke diagnosis for these challenging cases.
Area of Science:
- Neurology
- Emergency Medicine
- Diagnostic Tools
Background:
- Vertigo and dizziness are common yet challenging symptoms in the emergency department (ED).
- Accurate and rapid diagnosis of stroke is critical in patients presenting with these symptoms.
- Existing diagnostic tools may lack sufficient accuracy for stroke identification in this population.
Purpose of the Study:
- To develop and evaluate a new diagnostic score, TriAGe+, for identifying stroke in patients with vertigo or dizziness.
- To compare the performance of the TriAGe+ score against the established ABCD2 score.
Main Methods:
- A single-center observational study involving 498 patients presenting with vertigo or dizziness.
- Multivariate logistic regression analysis was used to derive predictor variables for the TriAGe+ score.
- The study evaluated the accuracy of TriAGe+ in predicting stroke occurrence.
Main Results:
- The TriAGe+ score, derived from eight variables, showed a significant increase in stroke prevalence with higher scores.
- At a cutoff of 10 points, TriAGe+ demonstrated 77.5% sensitivity and 72.1% specificity for stroke.
- The TriAGe+ score significantly outperformed the ABCD2 score (C statistic 0.818 vs. 0.726, P < .001).
Conclusions:
- The TriAGe+ score is a valuable tool for identifying stroke in emergency department patients with vertigo or dizziness.
- The new score offers improved diagnostic accuracy compared to the ABCD2 score for this patient group.
Background:
Vertigo or dizziness is a common occurrence, but it remains a challenging symptom when encountered in the emergency department (ED). A diagnostic score for stroke with high accuracy is therefore required.
Methods:
A single-center observational study (498 patients) was conducted. The predictor variables were derived from a multivariate logistic regression analysis with Akaike information criterion. The outcome was the occurrence of stroke. We evaluated the utility of a new diagnostic score (TriAGe+) and compared it with the ABCD2 score.
Results:
The cohorts included 498 patients (147 with stroke [29.4%]). Eight variables were included: triggers, atrial fibrillation, male gender, blood pressure ≥140/90 mm Hg, brainstem or cerebellar dysfunction, focal weakness or speech impairment, dizziness, and no history of vertigo or dizziness or labyrinth or vestibular disease. We derived the TriAGe+ score from these variables. In the cohort, the prevalence of stroke increased significantly using the diagnostic score: 5.9% for a score of 0-4; 9.1% for 5-7; 24.7% for 8-9; and 57.3% for 10-17. At a cutoff value of 10 points, the sensitivity of the score was 77.5%, the specificity was 72.1%, and the positive likelihood ratio was 3.2. When the cutoff was defined as 5 points, the score obtained a high sensitivity (96.6%) with a good negative likelihood ratio (.15). The new score outperformed the ABCD2 score for the occurrence of stroke (C statistic, .818 versus .726; P < .001).
Conclusions:
The TriAGe+ score can identify the occurrence of stroke in patients with vertigo or dizziness presenting to the ED.
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