Cumulative Incidence of Stroke Disability and Mortality Following Emergency Department Discharge for Dizziness: A...

The incidence of stroke after emergency department (ED) dizziness visits is low, indicating that missed strokes, a subset of subsequent strokes, are infrequent. However, little is known about the outcomes of individuals with subsequent stroke. This study estimates the incidence of stroke disability/mortality after ED dizziness visits.

We conducted a retrospective cohort study from January 2016 to December 2020 within Kaiser Permanente Southern California. We included all index visits for adults discharged home after an ED dizziness visit. Stroke hospitalization and stroke hospitalization with disability/mortality (subsequent stroke hospitalization discharged to any setting other than back to home) were captured over a 30-day follow-up period. Cumulative incidence of stroke disability/mortality was calculated using Kaplan-Meier estimates. Acute stroke management and stroke location on imaging were also summarized.

We identified 77,315 index ED dizziness visits discharged home. The 30-day cumulative incidence of stroke hospitalization was 0.12% (95% confidence interval [CI] 0.10 to 0.15; n=94; 1 in ∼830), and the cumulative incidence of stroke hospitalization with disability/mortality was 0.04% (95% CI 0.03 to 0.06; n=33; 1 in ∼2,500). Among subsequent strokes, most lesions were in the anterior fossa on imaging (59%; 55/94). The frequency of acute interventions was as follows: 1% (1/94) thrombolytics, 5% (5/94) thrombectomy, 2% (2/94) suboccipital craniotomy, 3% (3/94) tracheostomy, 3% (3/94) gastrostomy, and 10% (9/94) mechanical intubation.

At the individual level, stroke that results in death or severe disability after discharge to home from an ED dizziness visit is rare. Because only a subset of the subsequent visits are likely to be directly related to the index visit, the frequency of missed strokes leading to death or disability should be considered to be even lower.