Ischemic Stroke Predictors in Patients Presenting with Dizziness, Imbalance, and Vertigo

Objects: To identify predictors of acute ischemic stroke (AIS) among patients presenting to the Emergency Department (ED) with dizziness, imbalance, or vertigo (DIV) based on demographic and clinical characteristics. Methods: We identified patients admitted to the hospital after presenting to the ED with DIV from the State-wide Planning and Research Cooperative System database of New York from 2010 to 2014. Demographic and clinical characteristics were systematically collected. Multivariable logistic regression was used to determine predictors of a discharge diagnosis of AIS. Results: Among 77,993 patients with DIV, 3857 (4.9%) had a discharge diagnosis of AIS. Admission presentation of imbalance, African-American race, history of hypertension, diabetes mellitus, hypercholesterolemia, tobacco use, atrial fibrillation, and prior AIS due to extracranial artery atherosclerosis were each positively associated with an AIS diagnosis independently. Factors negatively associated with an AIS discharge diagnosis included: admission presentation of vertigo, female sex, age > 81, history of anemia, coronary artery disease, asthma, depressive disorders, and anxiety disorders. Conclusions: Multiple potential positive and negative predictive AIS risk factors were identified. Combining with currently available centrally-caused dizziness prediction tools, these newly identified factors could provide more accurate AIS risk stratifying method for DIV patients.