Prevalence and Predictors of Stroke Among Patients Presenting to the Emergency Department with Dizziness: A Retrospective Cohort Study
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e76
https://doi.org/10.22037/aaem.v13i1.2764
Abstract
Introduction: Dizziness is a frequent emergency department (ED) complaint, often benign but sometimes due to serious underlying etiologies, including cerebrovascular diseases. This study aimed to estimate stroke prevalence among ED dizzy patients and determine its predictors.
Methods: This retrospective cohort study was performed at King Fahad Hospital of the University, reviewing all adult ED visits with documented dizziness from January–December 2023. Patients with incomplete records were excluded. Demographics, comorbidities, vital signs, and clinical features were studied and independent predictors of stroke among dizzy patients were identified using Logistic regression analysis.
Results: A total of 1,660 records were reviewed and 950 adult patients with the mean age of 42.0 ± 16.2 (range 18-93) years were included. The prevalence of stroke was 0.74% (95% confidence interval (CI): 0.35 to 1.54). The prevalence was higher among males (1.60%) and patients aged 50-60 years (2.09%). Male sex (odds ratio (OR): 9.33, 95% CI: 1.12 to 77.8; p = 0.039), older age (OR: 1.05, 95% CI: 1.01 to 1.10; p = 0.017), smoking (OR: 21.8, 95% CI: 3.95 to 120; p < 0.001), diabetes (OR: 24.6, 95% CI: 2.94 to 205; p = 0.003), hypertension (OR: 5.25, 95% CI: 1.17 to 23.7; p = 0.031), hyperlipidaemia (OR:19.9, 95% CI: 4.37 to 91.3; p < 0.0001), tinnitus (OR:10.3, 95% CI: 1.17 to 90.9; p = 0.036), antiplatelet medications (OR: 8.80, 95% CI: 1.66 to 46.7; p = 0.011), and higher systolic blood pressure (OR: 1.04, 95% CI: 1.02 to 1.08; 0.001) were associated with an increased risk of stroke. In addition, presence of any focal neurologic deficit was significantly associated with the higher probability of stroke in dizzy patients. In the final logistic regression model, smoking (adjusted OR (aOR): 22.7, 95% CI: 2.96 to 174; p = 0.003), hyperlipidemia (aOR: 20.2, 95% CI: 3.45 to 117; p = 0.001), and systolic blood pressure (aOR: 1.06, 95% CI: 1.02 to 1.10; p = 0.001) remained significant independent predictors of stroke risk in dizzy patients who referred to the ED.
Conclusion: Based on the finding of this series, the prevalence of stroke among dizzy patients was 0.74%. Older age, male sex, smoking, diabetes mellitus, hyperlipidaemia, tinnitus, antiplatelet medications, presence of focal neurologic deficit, and higher systolic blood pressure were among the associated factors of stroke in dizzy patients based on univariate analysis. Based on the final models, smoking, hyperlipidemia and increase systolic blood pressure were among the independent predictors of stroke in dizzy cases.
- Dizziness
- Stroke
- Emergency Department
- Prevalence
- Risk Factors
How to Cite
References
Newman-Toker DE, Hsieh YH, Camargo CA, Jr., Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83(7):765-75.
Chan Y. Differential diagnosis of dizziness. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):200-3.
Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82.
CDC stroke. Stroke facts 2024 [Available from: https://www.cdc.gov/stroke/data-research/facts-stats/index.html.
Lecouturier J, Murtagh MJ, Thomson RG, Ford GA, White M, Eccles M, et al. Response to symptoms of stroke in the UK: a systematic review. BMC Health Serv Res. 2010;10:157.
Yew KS, Cheng EM. Diagnosis of acute stroke. Am Fam Physician. 2015;91(8):528-36.
Saber Tehrani AS, Kattah JC, Kerber KA, Gold DR, Zee DS, Urrutia VC, et al. Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls. Stroke. 2018;49(3):788-95.
Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37(10):2484-7.
Herr RD, Zun L, Mathews JJ. A directed approach to the dizzy patient. Ann Emerg Med. 1989;18(6):664-72.
Kroenke K, Hoffman RM, Einstadter D. How common are various causes of dizziness? A critical review. South Med J. 2000;93(2):160-7.
Madlon-Kay DJ. Evaluation and outcome of the dizzy patient. J Fam Pract. 1985;21(2):109-13.
Cheung CS, Mak PS, Manley KV, Lam JM, Tsang AY, Chan HM, et al. Predictors of important neurological causes of dizziness among patients presenting to the emergency department. Emerg Med J. 2010;27(7):517-21.
Navi BB, Kamel H, Shah MP, Grossman AW, Wong C, Poisson SN, et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc. 2012;87(11):1080-8.
Kim JS, Bae HJ, Kim M, Ahn S, Sohn CH, Seo DW, et al. Stroke prediction in patients presenting with isolated dizziness in the emergency department. Sci Rep. 2021;11(1):6114.
Kim Y, Faysel M, Balucani C, Yu D, Gilles N, Levine SR. Ischemic Stroke Predictors in Patients Presenting with Dizziness, Imbalance, and Vertigo. J Stroke Cerebrovasc Dis. 2018;27(12):3419-24.
NHLBI NIH. Stroke - causes and risk factors 2023 [Available from: https://www.nhlbi.nih.gov/health/stroke/causes.
Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. Am J Med Sci. 2016;351(4):380-6.
Alloubani A, Nimer R, Samara R. Relationship between Hyperlipidemia, Cardiovascular Disease and Stroke: A Systematic Review. Curr Cardiol Rev. 2021;17(6):e051121189015.
Wang C, Du Z, Ye N, Shi C, Liu S, Geng D, et al. Hyperlipidemia and hypertension have synergistic interaction on ischemic stroke: insights from a general population survey in China. BMC Cardiovasc Disord. 2022;22(1):47.
Kolmos M, Christoffersen L, Kruuse C. Recurrent Ischemic Stroke - A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis. 2021;30(8):105935.
Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS, et al. Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke. 1998;29(12):2491-500.
Uzuner N, Uzuner GT. Risk factors for multiple recurrent ischemic strokes. Brain Circ. 2023;9(1):21-4.
Pan B, Jin X, Jun L, Qiu S, Zheng Q, Pan M. The relationship between smoking and stroke: A meta-analysis. Medicine (Baltimore). 2019;98(12):e14872.
Ausland JH, Engdahl B, Oftedal B, Hopstock LA, Johnsen M, Krog NH. Tinnitus and cardiovascular disease: the population-based Tromsø Study (2015-2016). BMJ Public Health. 2024;2(2):e000621.
Al-Shahi Salman R, Dennis MS, Sandercock PAG, Sudlow CLM, Wardlaw JM, Whiteley WN, et al. Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage: Extended Follow-up of the RESTART Randomized Clinical Trial. JAMA Neurol. 2021;78(10):1179-86.
Kamarova M, Baig S, Patel H, Monks K, Wasay M, Ali A, et al. Antiplatelet Use in Ischemic Stroke. Ann Pharmacother. 2022;56(10):1159-73.
- Abstract Viewed: 271 times
- pdf Downloaded: 379 times
Download Statastics
Make a Submission
SJR
COPE
