Jacob Johanna L, Rashid Urouj, Lee Chel H, Menon Bijoy K, Lin Katie
Neuroscience, University of Alberta, Edmonton, CAN.
Biological Sciences, University of Calgary, Calgary, CAN.
Cureus. 2024 Nov 19;16(11):e74041. doi: 10.7759/cureus.74041. eCollection 2024 Nov.
A subset of undifferentiated vertigo cases can be attributed to dangerous central causes such as posterior circulation ischemic stroke (PCIS) or transient ischemic attack (TIA). Due to a lack of validated clinical risk scoring tools, there is currently high heterogeneity in emergency department (ED) neuroimaging practices for patients presenting with undifferentiated vertigo. Therefore, this study assessed the utility of head and neck CT with angiography (CTA) for risk stratifying ED patients presenting with vertigo. The primary objective of this study was to compare 30-day stroke and TIA outcomes between ED vertigo patients who received CTA at their index visit versus those who did not. The impact of index visit CTA on secondary outcomes of interest was also measured, including ED length of stay (LOS), hospital LOS, and 30-day ED revisit rate.
This retrospective study analyzed ED visit data across four tertiary care ED's over a one-year period. Adult patients presenting with a chief complaint of vertigo were eligible for study inclusion. Administrative data of the variables of interest was gathered from Canadian medical databases. Regression modeling was used to adjust for predetermined variables to evaluate the association between index visit CTA imaging, and stroke or TIA diagnosis at 30 days.
A 30-day diagnosis for stroke or TIA was found in 20.7% of the CTA group, and in 1.2% of the No CTA group. The odds ratio (OR) was 22.3 (95% confidence interval (CI): 15.03-33.02) unadjusted, and 18.3 (95% CI: 14.85-22.45) after adjustment. The CTA group had a longer average ED LOS (+114 minutes), a shorter average total hospital LOS within 30 days (-2.2 days), and a higher 30-day ED revisit rate when compared to the No CTA group (4.0% versus 1.5%).
Patients who received CTA at their index visit had 18.3 times greater odds of TIA or stroke diagnosis at 30-days, stayed longer in the ED, were more likely to revisit the ED within 30 days, and had a shorter mean hospital stay.
一部分未分化眩晕病例可归因于危险的中枢性病因，如后循环缺血性卒中（PCIS）或短暂性脑缺血发作（TIA）。由于缺乏经过验证的临床风险评分工具，目前急诊科（ED）对未分化眩晕患者进行神经影像学检查的做法存在很大差异。因此，本研究评估了头部和颈部CT血管造影（CTA）对急诊科眩晕患者进行风险分层的效用。本研究的主要目的是比较初次就诊时接受CTA检查的急诊科眩晕患者与未接受CTA检查的患者在30天内的卒中及TIA结局。还评估了初次就诊CTA对其他感兴趣的次要结局的影响，包括急诊科住院时间（LOS）、住院总时长以及30天内急诊科复诊率。
这项回顾性研究分析了四家三级医疗急诊科在一年期间的急诊就诊数据。以眩晕为主诉的成年患者符合纳入研究的条件。从加拿大医疗数据库收集了感兴趣变量的管理数据。使用回归模型对预定变量进行调整，以评估初次就诊CTA成像与30天时卒中或TIA诊断之间的关联。
CTA组中20.7%的患者在30天时被诊断为卒中或TIA，未进行CTA检查的组中这一比例为1.2%。未调整的优势比（OR）为22.3（95%置信区间（CI）：15.03 - 33.02），调整后为18.3（95% CI：14.85 - 22.45）。与未进行CTA检查的组相比，CTA组的急诊科平均住院时间更长（+114分钟），30天内的平均住院总时长更短（-2.2天），30天内急诊科复诊率更高（4.0%对1.5%）。
初次就诊时接受CTA检查的患者在30天时被诊断为TIA或卒中的几率高18.3倍，在急诊科停留时间更长，30天内更有可能再次前往急诊科就诊，且平均住院时间更短。
