A clinical decision rule to exclude central vertigo in the emergency department: A prospective, multicenter, observational study

To ensure good outcomes in patients presenting with vertigo, accurate prediction ruling out central vertigo is crucial during initial assessment. This study was conducted to develop a clinical decision rule (CDR) using objectively measurable predictors to exclude central vertigo, while maintaining 100% sensitivity. This was a multicenter, prospective, cohort study analyzing patients presenting to the emergency departments of six hospitals in Japan from April 2011 to March 2014. Eligible patients were 3,001 patients aged > 15 years. Patients were excluded if they presented with trauma, intoxication, heatstroke, anaphylaxis, or unconsciousness. The main outcome measure, definitive diagnosis of central vertigo, was based on confirmation of intracranial bleeding on head computed tomography (CT) or cerebral or cerebellar infarction or tumor on brain magnetic resonance imaging (MRI). Univariate analysis and multivariate recursive partitioning analysis were performed. A total of 1,938 patients were enrolled. Of 1,133 cases, 60 were diagnosed with central vertigo. The CDR diagnosed central vertigo if any of the following were present: headache or neck pain, vomiting, sBP > 150 mmHg, BS > 140 mg/dL, or LDH > 230 IU/L, providing sensitivity of 100% (95% CI 94.0–100%) and specificity of 21.2% (95% CI: 18.9–23.7%) to exclude central vertigo. The rule was validated in 805 eligible patients, of whom 87 had central vertigo, demonstrating sensitivity of 100% (95% CI: 95.8–100%) and specificity of 20.0% (95% CI: 17.4–22.9%). A highly sensitive CDR to exclude central vertigo was developed for patients presenting with vertigo to emergency departments. Further verification is needed to generalize this CDR.