Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study
OBJECTIVE:To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations. METHODS:Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, o...
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| Veröffentlicht in: | Neurology 2015-11, Vol.85 (21), p.1869-1878 |
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| creator | Kerber, Kevin A Meurer, William J Brown, Devin L Burke, James F Hofer, Timothy P Tsodikov, Alexander Hoeffner, Ellen G Fendrick, A.M Adelman, Eric E Morgenstern, Lewis B |
| description | OBJECTIVE:To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.
METHODS:Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low ( |
| doi_str_mv | 10.1212/WNL.0000000000002141 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4662702</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1765972343</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3741-71c7a0e675622ec7c262e1e2d1a17a0fb56913a49a024df1f55c995ed69cf6703</originalsourceid><addsrcrecordid>eNqNUU1PGzEQtRAVpLT_AKE99rLU489dDkgI9UuK2gNU7amW451NTDa7qe0NIr--bkMR9FDhw1ia9-bpzTxCjoGeAgP29tvn6Sl99BgI2CMTkEyVirPv-2SSm1XJK10dkpcx3lCaQV0fkEOmJICQfEJ-XKUwLLEIPi6LmIJNvvUu16EvfF9YNyYsGr_d-h5jLNYBI_bpDx7PiovcGOIaXfIbLPzKzn0_L2c2YpPFxubuFXnR2i7i6_v_iHx9_-768mM5_fLh0-XFtHRcCyg1OG0pKi0VY-i0Y4ohIGvAQgbamVQ1cCtqS5loWmildHUtsVG1a5Wm_Iic73TX42yFjcseg-3MOmRP4c4M1punSO8XZj5sjFCKacqywJt7gTD8HDEms_LRYdfZHocxGtBK1ppxwZ9B5UqAVJXIVLGjunymGLB9cATU_E7R5BTNvynmsZPH2zwM_Y0tE6od4XboEoa47MZbDGaBtkuL_2v_AjGGqwg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1736415684</pqid></control><display><type>article</type><title>Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>Kerber, Kevin A ; Meurer, William J ; Brown, Devin L ; Burke, James F ; Hofer, Timothy P ; Tsodikov, Alexander ; Hoeffner, Ellen G ; Fendrick, A.M ; Adelman, Eric E ; Morgenstern, Lewis B</creator><creatorcontrib>Kerber, Kevin A ; Meurer, William J ; Brown, Devin L ; Burke, James F ; Hofer, Timothy P ; Tsodikov, Alexander ; Hoeffner, Ellen G ; Fendrick, A.M ; Adelman, Eric E ; Morgenstern, Lewis B</creatorcontrib><description>OBJECTIVE:To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.
METHODS:Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low (<5%), intermediate (5% to <10%), and high (≥10%) predicted probability risk categories.
RESULTS:Acute stroke was identified in 29 of 272 patients (10.7%). Associations with stroke were as followsABCD score (continuous) (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.20–2.51), any other CNS features (OR 2.54; 95% CI 1.06–6.08), OM assessment (OR 2.82; 95% CI 0.96–8.30), and prior stroke (OR 0.48; 95% CI 0.05–4.57). No stroke cases were in the modelʼs low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%).
CONCLUSION:In acute dizziness presentations, the combination of ABCD score, general neurologic examination, and a specialized OM examination has the capacity to risk-stratify acute stroke on MRI.</description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000002141</identifier><identifier>PMID: 26511453</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Acute Disease ; Adult ; Aged ; Dizziness - diagnosis ; Dizziness - etiology ; Dizziness - metabolism ; Emergency Service, Hospital - trends ; Female ; Humans ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Stroke - complications ; Stroke - diagnosis ; Stroke - metabolism</subject><ispartof>Neurology, 2015-11, Vol.85 (21), p.1869-1878</ispartof><rights>2015 American Academy of Neurology</rights><rights>2015 American Academy of Neurology.</rights><rights>2015 American Academy of Neurology 2015 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3741-71c7a0e675622ec7c262e1e2d1a17a0fb56913a49a024df1f55c995ed69cf6703</citedby><cites>FETCH-LOGICAL-c3741-71c7a0e675622ec7c262e1e2d1a17a0fb56913a49a024df1f55c995ed69cf6703</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26511453$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kerber, Kevin A</creatorcontrib><creatorcontrib>Meurer, William J</creatorcontrib><creatorcontrib>Brown, Devin L</creatorcontrib><creatorcontrib>Burke, James F</creatorcontrib><creatorcontrib>Hofer, Timothy P</creatorcontrib><creatorcontrib>Tsodikov, Alexander</creatorcontrib><creatorcontrib>Hoeffner, Ellen G</creatorcontrib><creatorcontrib>Fendrick, A.M</creatorcontrib><creatorcontrib>Adelman, Eric E</creatorcontrib><creatorcontrib>Morgenstern, Lewis B</creatorcontrib><title>Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study</title><title>Neurology</title><addtitle>Neurology</addtitle><description>OBJECTIVE:To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.
METHODS:Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low (<5%), intermediate (5% to <10%), and high (≥10%) predicted probability risk categories.
RESULTS:Acute stroke was identified in 29 of 272 patients (10.7%). Associations with stroke were as followsABCD score (continuous) (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.20–2.51), any other CNS features (OR 2.54; 95% CI 1.06–6.08), OM assessment (OR 2.82; 95% CI 0.96–8.30), and prior stroke (OR 0.48; 95% CI 0.05–4.57). No stroke cases were in the modelʼs low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%).
CONCLUSION:In acute dizziness presentations, the combination of ABCD score, general neurologic examination, and a specialized OM examination has the capacity to risk-stratify acute stroke on MRI.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Dizziness - diagnosis</subject><subject>Dizziness - etiology</subject><subject>Dizziness - metabolism</subject><subject>Emergency Service, Hospital - trends</subject><subject>Female</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - complications</subject><subject>Stroke - diagnosis</subject><subject>Stroke - metabolism</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1PGzEQtRAVpLT_AKE99rLU489dDkgI9UuK2gNU7amW451NTDa7qe0NIr--bkMR9FDhw1ia9-bpzTxCjoGeAgP29tvn6Sl99BgI2CMTkEyVirPv-2SSm1XJK10dkpcx3lCaQV0fkEOmJICQfEJ-XKUwLLEIPi6LmIJNvvUu16EvfF9YNyYsGr_d-h5jLNYBI_bpDx7PiovcGOIaXfIbLPzKzn0_L2c2YpPFxubuFXnR2i7i6_v_iHx9_-768mM5_fLh0-XFtHRcCyg1OG0pKi0VY-i0Y4ohIGvAQgbamVQ1cCtqS5loWmildHUtsVG1a5Wm_Iic73TX42yFjcseg-3MOmRP4c4M1punSO8XZj5sjFCKacqywJt7gTD8HDEms_LRYdfZHocxGtBK1ppxwZ9B5UqAVJXIVLGjunymGLB9cATU_E7R5BTNvynmsZPH2zwM_Y0tE6od4XboEoa47MZbDGaBtkuL_2v_AjGGqwg</recordid><startdate>20151124</startdate><enddate>20151124</enddate><creator>Kerber, Kevin A</creator><creator>Meurer, William J</creator><creator>Brown, Devin L</creator><creator>Burke, James F</creator><creator>Hofer, Timothy P</creator><creator>Tsodikov, Alexander</creator><creator>Hoeffner, Ellen G</creator><creator>Fendrick, A.M</creator><creator>Adelman, Eric E</creator><creator>Morgenstern, Lewis B</creator><general>American Academy of Neurology</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope><scope>5PM</scope></search><sort><creationdate>20151124</creationdate><title>Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study</title><author>Kerber, Kevin A ; Meurer, William J ; Brown, Devin L ; Burke, James F ; Hofer, Timothy P ; Tsodikov, Alexander ; Hoeffner, Ellen G ; Fendrick, A.M ; Adelman, Eric E ; Morgenstern, Lewis B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3741-71c7a0e675622ec7c262e1e2d1a17a0fb56913a49a024df1f55c995ed69cf6703</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Dizziness - diagnosis</topic><topic>Dizziness - etiology</topic><topic>Dizziness - metabolism</topic><topic>Emergency Service, Hospital - trends</topic><topic>Female</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - complications</topic><topic>Stroke - diagnosis</topic><topic>Stroke - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kerber, Kevin A</creatorcontrib><creatorcontrib>Meurer, William J</creatorcontrib><creatorcontrib>Brown, Devin L</creatorcontrib><creatorcontrib>Burke, James F</creatorcontrib><creatorcontrib>Hofer, Timothy P</creatorcontrib><creatorcontrib>Tsodikov, Alexander</creatorcontrib><creatorcontrib>Hoeffner, Ellen G</creatorcontrib><creatorcontrib>Fendrick, A.M</creatorcontrib><creatorcontrib>Adelman, Eric E</creatorcontrib><creatorcontrib>Morgenstern, Lewis B</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kerber, Kevin A</au><au>Meurer, William J</au><au>Brown, Devin L</au><au>Burke, James F</au><au>Hofer, Timothy P</au><au>Tsodikov, Alexander</au><au>Hoeffner, Ellen G</au><au>Fendrick, A.M</au><au>Adelman, Eric E</au><au>Morgenstern, Lewis B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2015-11-24</date><risdate>2015</risdate><volume>85</volume><issue>21</issue><spage>1869</spage><epage>1878</epage><pages>1869-1878</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><abstract>OBJECTIVE:To estimate the ability of bedside information to risk stratify stroke in acute dizziness presentations.
METHODS:Surveillance methods were used to identify patients with acute dizziness and nystagmus or imbalance, excluding those with benign paroxysmal positional vertigo, medical causes, or moderate to severe neurologic deficits. Stroke was defined as acute infarction or intracerebral hemorrhage on a clinical or research MRI performed within 14 days of dizziness onset. Bedside information comprised history of stroke, the ABCD score (age, blood pressure, clinical features, duration, and diabetes), an ocular motor (OM)-based assessment (head impulse test, nystagmus pattern [central vs other], test of skew), and a general neurologic examination for other CNS features. Multivariable logistic regression was used to determine the association of the bedside information with stroke. Model calibration was assessed using low (<5%), intermediate (5% to <10%), and high (≥10%) predicted probability risk categories.
RESULTS:Acute stroke was identified in 29 of 272 patients (10.7%). Associations with stroke were as followsABCD score (continuous) (odds ratio [OR] 1.74; 95% confidence interval [CI] 1.20–2.51), any other CNS features (OR 2.54; 95% CI 1.06–6.08), OM assessment (OR 2.82; 95% CI 0.96–8.30), and prior stroke (OR 0.48; 95% CI 0.05–4.57). No stroke cases were in the modelʼs low-risk probability category (0/86, 0%), whereas 9 were in the moderate-risk category (9/94, 9.6%) and 20 were in the high-risk category (20/92, 21.7%).
CONCLUSION:In acute dizziness presentations, the combination of ABCD score, general neurologic examination, and a specialized OM examination has the capacity to risk-stratify acute stroke on MRI.</abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>26511453</pmid><doi>10.1212/WNL.0000000000002141</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Aged Dizziness - diagnosis Dizziness - etiology Dizziness - metabolism Emergency Service, Hospital - trends Female Humans Magnetic Resonance Imaging - methods Male Middle Aged Prospective Studies Risk Factors Stroke - complications Stroke - diagnosis Stroke - metabolism |
| title | Stroke risk stratification in acute dizziness presentations: A prospective imaging-based study |
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