Background: Dizziness is a common chief complaint of patients presenting to the Emergency Department (ED).\nPhysicians must quickly and accurately identify patients whose etiology is most likely ischemia. Additional tools are\navailable, but often require further training (vestibular testing) or are costly and not always readily available\n(magnetic resonance imaging (MRI)). This study evaluates the ability of a routine history and simple physical\nexamination to correctly identify dizzy patients with posterior circulation ischemia, and the added utility of CT\nangiography (CTA).\nMethods: We performed a retrospective analysis of all individuals presenting to the ED with a reported chief\ncomplaint of dizziness. Neurology was consulted and CTA ordered at the discretion of the ED provider. Demographic,\nmedical, and radiographic variables were evaluated along with final diagnosis. Multivariable logistic regression and ROC\nanalysis were used to determine factors associated with ischemia, the sensitivity of vascular risk factors and focal exam\nfindings in predicting ischemia, and the additional benefit, if any, of CTA.\nResults: One thousand two-hundred sixteen individuals meeting inclusion criteria presented to the ED over a 2 year\nperiod and were included in analysis. One hundred (8.2 %) were diagnosed with posterior circulation ischemia. For the\nentire cohort, age (OR 1.4 per 10 years, p < 0.0001), systolic blood pressure (OR 1.3 per 10 mmHg, p < 0.0001), and focal\nexam findings (OR 28.69, p < 0.0001) were most significantly associated with ischemia in multivariable modeling. When\nage, race, sex, presence of vascular risk factors, and focal neurologic findings were entered into ROC analysis, the AUC\nfor correctly identifying posterior circulation ischemia was 0.90. In the subset of patients who underwent CTA (n = 87),\nthe AUC did not improve (0.78 with and without CTA in ROC analysis, p = 0.52).\nConclusions: A vascular risk assessment and neurological examination are adequate for risk stratification of ischemia in\nthe dizzy patient and should remain the standard evaluation
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