Ohle Robert, Savage David W, Roy Danielle, McIsaac Sarah, Singh Ravinder, Lelli Daniel, Tse Darren, Johns Peter, Yadav Krishan, Perry Jeffrey J
Department of Emergency Medicine, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada.
Department of Emergency Medicine, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
Ann Emerg Med. 2025 Feb;85(2):122-131. doi: 10.1016/j.annemergmed.2024.06.003. Epub 2024 Aug 1.
Identify high-risk clinical characteristics for a serious cause of vertigo in patients presenting to the emergency department (ED).
Multicentre prospective cohort study over 3 years at three university-affiliated tertiary care EDs. Participants were patients presenting with vertigo, dizziness or imbalance. Main outcome measurement was an adjudicated serious diagnosis defined as stroke, transient ischemic attack, vertebral artery dissection or brain tumour.
A total of 2,078 of 2,618 potentially eligible patients (79.4%) were enrolled (mean age 77.1 years; 59% women). Serious events occurred in 111 (5.3%) patients. We used logistic regression to create a 7-item prediction model: male, age over 65, hypertension, diabetes, motor/sensory deficits, cerebellar signs/symptoms and benign paroxysmal positional vertigo diagnosis (C-statistic 0.96, 95% confidence interval [CI] 0.92 to 0.98). The risk of a serious diagnosis ranged from 0% for a score of <5, 2.1% for a score of 5 to 8, and 41% for a score >8. Sensitivity for a serious diagnosis was 100% (95% CI, 97.1% to 100%) and specificity 72.1% (95% CI, 70.1% to 74%) for a score <5.
The Sudbury Vertigo Risk Score identifies the risk of a serious diagnosis as a cause of a patient's vertigo and if validated could assist physicians in guiding further investigation, consultation, and treatment decisions, improving resource utilization and reducing missed diagnoses.
确定急诊科（ED）就诊的眩晕患者存在严重病因的高风险临床特征。
在三所大学附属医院的三级医疗急诊科进行了为期3年的多中心前瞻性队列研究。参与者为出现眩晕、头晕或失衡症状的患者。主要结局指标是经判定的严重诊断，定义为中风、短暂性脑缺血发作、椎动脉夹层或脑肿瘤。
2618名潜在符合条件的患者中，共有2078名（79.4%）被纳入研究（平均年龄77.1岁；59%为女性）。111名（5.3%）患者发生了严重事件。我们使用逻辑回归创建了一个包含7项的预测模型：男性、年龄超过65岁、高血压、糖尿病、运动/感觉缺陷、小脑体征/症状以及良性阵发性位置性眩晕诊断（C统计量为0.96，95%置信区间[CI]为0.92至0.98）。严重诊断的风险范围为：得分<5时为0%，得分5至8时为2.1%，得分>8时为41%。得分<5时，严重诊断的敏感性为100%（95%CI，97.1%至100%），特异性为72.1%（95%CI，70.1%至74%）。
萨德伯里眩晕风险评分可识别患者眩晕病因的严重诊断风险，若经验证，可协助医生指导进一步检查、会诊及治疗决策，提高资源利用效率并减少漏诊。
