Mandge Vishal, Palaiodimos Leonidas, Lai Qingying, Papanastasiou Christos A, Wang Yanjun, Santos Daniel, Grau Luis, Kodali Alimitha, Ocava Lenore, Gutwein Andrew H
Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, NC, USA.
Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; NYC Health+Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY, USA.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105043. doi: 10.1016/j.jstrokecerebrovasdis.2020.105043. Epub 2020 Jun 25.
Acute vertigo (sense of motion) can be the sole manifestation of a posterior circulation stroke, and often gets missed in the emergency department (ED). The studies for evaluation of central vertigo have focused on physical exam findings, which require expertise and may not be suitable for rapid triage by a nurse in ED or by paramedics.
This cross sectional study included retrospective chart review of patients 18 years of age and older who presented to the Adult ED with acute dizziness or vertigo during the calendar year 2017. All the patients with a diagnosis of central or peripheral vertigo were included in the final analysis. Sensitivity, specificity, Likelihood Ratio of positive result (LR (+)) and Likelihood Ratio of negative result (LR (-)) for central and peripheral vertigo were calculated for risk factors, symptoms and physical examination features. Chi-squared test and univariate logistic regression were used to evaluate statistical correlation and to calculate the prevalence odds ratio (POR).
Two hundred and forty nine out of 505 (49.3%) patients presenting with dizziness had vertigo. Of these, 14 had central vertigo and 163 had peripheral vertigo. Statistically significant variables were: constant symptoms of vertigo (p 0.000- POR 8.7, 95% confidence interval (CI) 2.3-33.1), no change in symptoms with head movement (p 0.000- POR 10.2, 95% CI 3.0-35.4), dysmetria (p 0.000- POR 56.8, 95% CI 5.8-557.1), and unsteady gait (p 0.000- POR 13.3, 95% CI 3.3-54.3). The sensitivity and specificity to detect central vertigo were 100% and 66.4% respectively if the patient had either unsteady gait, constant symptoms, or no change in symptoms with head movement, [VAIN triad (Vertigo- Ataxia, Incessant, or Non-positional)].
We suggest that triage with VAIN triad can be used to design prospective studies to develop a triage algorithm for the detection of central vertigo in the ED.
急性眩晕（运动感）可能是后循环卒中的唯一表现，在急诊科（ED）常被漏诊。评估中枢性眩晕的研究主要集中在体格检查结果上，这需要专业知识，可能不适合急诊科护士或护理人员进行快速分诊。
这项横断面研究包括对2017年期间到成人急诊科就诊的18岁及以上急性头晕或眩晕患者的病历进行回顾性分析。所有诊断为中枢性或周围性眩晕的患者均纳入最终分析。计算中枢性和周围性眩晕的危险因素、症状和体格检查特征的敏感性、特异性、阳性似然比（LR(+)）和阴性似然比（LR(-)）。采用卡方检验和单因素逻辑回归评估统计相关性并计算患病率比值比（POR）。
505例出现头晕的患者中，249例（49.3%）有眩晕。其中，14例为中枢性眩晕，163例为周围性眩晕。具有统计学意义的变量为：持续性眩晕症状（p 0.000 - POR 8.7，95%置信区间（CI）2.3 - 33.1）、头部运动时症状无变化（p 0.000 - POR 10.2，95% CI 3.0 - 35.4）、辨距不良（p 0.000 - POR 56.8，95% CI 5.8 - 557.1）和步态不稳（p 0.000 - POR 13.3，95% CI 3.3 - 54.3）。如果患者存在步态不稳、持续性症状或头部运动时症状无变化[VAIN三联征（眩晕 - 共济失调、持续性或非位置性）]，检测中枢性眩晕的敏感性和特异性分别为100%和66.4%。
我们建议采用VAIN三联征进行分诊，可用于设计前瞻性研究，以开发一种在急诊科检测中枢性眩晕的分诊算法。
