急诊就诊患者头晕的重要神经病因预测因素。

Predictors of important neurological causes of dizziness among patients presenting to the emergency department.

机构信息

Emergency Department, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, PR China.

出版信息

Emerg Med J. 2010 Jul;27(7):517-21. doi: 10.1136/emj.2009.078014.

DOI:10.1136/emj.2009.078014

PMID:20584952

Abstract

OBJECTIVES

Dizziness is a common presenting complaint in the emergency department (ED). This prospective study describes the incidence, causes and outcome of ED patients presenting with dizziness and tries to identify predictors of central neurological causes of dizziness.

METHODS

Single-centre prospective observational study in a university teaching hospital ED in Hong Kong. All ED patients (> or = 18 years old) presenting with dizziness were recruited for 1 month. Symptoms, previous health, physical findings, diagnosis and disposition were recorded. The outcome at 3 months was evaluated using hospital records and telephone interviews. Follow-up was also performed at 55 months using computerised hospital records to identify patients with subsequent stroke and those who had died.

RESULTS

413 adults (65% female, mean 57 years) were recruited. The incidence of dizziness was 3.6% (413/11 319). Nausea and/or vomiting (46%) and headache (20%) were the commonest associated findings. Hypertension (33%) was the commonest previous illness. Central neurological causes of dizziness were found in 6% (23/413) of patients. Age > or = 65 years (OR=6.13, 95% CI 1.97 to 19.09), ataxia symptoms (OR=11.39, 95% CI 2.404 to 53.95), focal neurological symptoms (OR=11.78, 95% CI 1.61 to 86.29), and history of previous stroke (OR=3.89, 95% CI 1.12 to 13.46) and diabetes mellitus (OR=3.57, 95% CI 1.04 to 12.28) predicted central causes of dizziness.

CONCLUSIONS

Most dizzy patients had benign causes. Several clinical factors favoured a diagnosis of central neurological causes of dizziness.

摘要

目的

头晕是急诊科（ED）常见的就诊主诉。本前瞻性研究描述了 ED 以头晕就诊患者的发生率、病因和转归，并试图确定头晕的中枢神经系统病因的预测因素。

方法

在香港一所大学教学医院的 ED 进行单中心前瞻性观察性研究。所有年龄≥18 岁、以头晕为主诉的 ED 患者均纳入研究，观察时间为 1 个月。记录症状、既往健康状况、体格检查结果、诊断和处置。3 个月时通过医院病历和电话访谈评估结局。55 个月时还通过计算机化的医院病历进行随访，以识别后续发生卒中的患者和死亡患者。

结果

共纳入 413 例成年人（65%为女性，平均年龄 57 岁）。头晕的发生率为 3.6%（413/11319）。最常见的伴随症状为恶心和/或呕吐（46%）和头痛（20%）。最常见的既往疾病为高血压（33%）。头晕的中枢神经系统病因在 6%（23/413）的患者中被发现。年龄≥65 岁（OR=6.13，95%CI 1.97 至 19.09）、共济失调症状（OR=11.39，95%CI 2.404 至 53.95）、局灶性神经症状（OR=11.78，95%CI 1.61 至 86.29）、既往卒中史（OR=3.89，95%CI 1.12 至 13.46）和糖尿病（OR=3.57，95%CI 1.04 至 12.28）预测头晕的中枢性病因。