• Robert Ohle, David W Savage, Danielle Roy, Sarah McIsaac, Ravinder Singh, Daniel Lelli, Darren Tse, Peter Johns, Krishan Yadav, and Jeffrey J Perry.
• Department of Emergency Medicine, Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, ON, Canada. Electronic address: Robert.ohle@gmail.com.
• Ann Emerg Med. 2024 Aug 1.

Study ObjectiveIdentify high-risk clinical characteristics for a serious cause of vertigo in patients presenting to the emergency department (ED).MethodsMulticentre prospective cohort study over 3 years at three university-affiliated tertiary care EDs. Participants were patients presenting with vertigo, dizziness or imbalance. Main outcome measurement was an adjudicated serious diagnosis defined as stroke, transient ischemic attack, vertebral artery dissection or brain tumour.ResultsA total of 2,078 of 2,618 potentially eligible patients (79.4%) were enrolled (mean age 77.1 years; 59% women). Serious events occurred in 111 (5.3%) patients. We used logistic regression to create a 7-item prediction model: male, age over 65, hypertension, diabetes, motor/sensory deficits, cerebellar signs/symptoms and benign paroxysmal positional vertigo diagnosis (C-statistic 0.96, 95% confidence interval [CI] 0.92 to 0.98). The risk of a serious diagnosis ranged from 0% for a score of <5, 2.1% for a score of 5 to 8, and 41% for a score >8. Sensitivity for a serious diagnosis was 100% (95% CI, 97.1% to 100%) and specificity 72.1% (95% CI, 70.1% to 74%) for a score <5.ConclusionThe Sudbury Vertigo Risk Score identifies the risk of a serious diagnosis as a cause of a patient's vertigo and if validated could assist physicians in guiding further investigation, consultation, and treatment decisions, improving resource utilization and reducing missed diagnoses.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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