Abstract TMP57: Disabling Stroke is Uncommon After An Emergency Department Evaluation and Discharge for Dizziness Symptoms
Background: Given the general concern about stroke among emergency department (ED) patients with dizziness, we sought to evaluate the short-term outcomes in these patients.
Methods: We conducted a nested-case control study within a cohort of all adults who presented during 1 year to 19 EDs of a large Northern California integrated health program with a primary complaint of dizziness. Cases were defined as patients with an ischemic or hemorrhagic stroke within 90 days of the index ED visit based on a review of comprehensive medical records. Controls were randomly-selected from among the remaining cohort. A vascular neurologist adjudicated the stroke or stroke-free status of cases and controls. Disabling stroke was defined as stroke requiring inpatient rehabilitation or skilled nursing care. Descriptive statistics were based on the sampling fraction of the entire cohort.
Results: Among 9,731 patients with a primary complaint of dizziness, 145 (1.5%, 95% CI 1.3%-1.8%) patients were diagnosed with a new stroke. Most were diagnosed with stroke within two days and all new strokes were diagnosed within 10 days of the initial ED visit. Mean age for cases was 69.1 y compared to 63.5 y for controls (t-test, p<0.01). Most cases were already on an antithrombotic (112, 77%) or a statin (100, 74%) prior to the ED visit. Six cases (0.1% overall) had a fatal stroke and 24 cases (0.4% overall) had a disabling stroke, while 115 (1.8% overall) had non-disabling strokes and were well enough to be discharged home directly from the ED or after a brief inpatient stay (median 3 d [IQR 2-4 d]). Nearly all (11/12) of the patients that had initially been discharged home directly from the ED and that were later hospitalized for stroke were subsequently discharged home; one patient who had been diagnosed with a stroke in the initial ED, returned 4 days later to be placed into an inpatient rehabilitation facility.
Conclusion: Although ED patients with dizziness can develop disabling or fatal strokes, the vast majority of these strokes are recognized in the emergency department or during the subsequent hospitalization. Delayed recognition of stroke appears to be uncommon among dizzy patients evaluated in the emergency department and discharged home and seldom results in a disabling stroke.
- © 2012 by American Heart Association, Inc.