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Adult ED patients (\n                      <jats:italic>n<\/jats:italic>\n                      =4,135; mean age 62.5 years; 62% female) who underwent imaging (\n                      <jats:italic>n<\/jats:italic>\n                      =5,445 exams, approximately 89% CT and 11% MR) were included. Imaging exams with potentially clinically relevant findings were flagged for further review (\n                      <jats:italic>n<\/jats:italic>\n                      =291 exams and patients); these patients were separated into four separate groups based on their imaging findings: 1) acute actionable contributory to vertigo, 2) acute actionable non-contributory to vertigo, 3) non-acute actionable, or 4) non-actionable. Vertigo quality (constant, intermittent\/resolved spontaneously, no vertigo), acuity, neurological examination (including cerebellar signs and the Head-Impulse, Nystagmus, and Test-of-Skew [HINTS] exam), and intervention rates were analyzed within these subgroups using Fisher\u2019s exact and chi-square tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 5,445 exams, 291 (5.3%) were flagged with potentially relevant imaging findings. Of these exams, only 115 (2.1%) yielded actionable findings, and just 65 (1.2%) revealed acute central causes contributing to vertigo. In patients with positive imaging findings, constant vertigo was strongly associated with acute contributory pathology (98.5% in this group vs. 6.0% in other groups,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.0001). Acute onset was more frequent in acute contributory cases (63.1% vs. 40.8%,\n                      <jats:italic>p<\/jats:italic>\n                      =0.0006), as were abnormal HINTS or cerebellar signs (44.6% vs. 6.0%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.0001). Most patients with acute contributory findings received specialty consultations resulting in intervention (95.4%). Intermittent or resolved vertigo was commonly seen in patients with benign peripheral diagnoses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Neuroimaging frequently yields normal results in ED vertigo cases; acute actionable central findings deemed contributory to vertigo are rare. Only approximately 2% of patients had acute actionable imaging findings and only 1.3% had a stroke. In patients with acute actionable imaging findings, clinical features\u2014especially constant vertigo, acute onset, and abnormal neurological exam\u2014are strongly associated with central causes and should guide selective imaging in the ED.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10140-025-02426-2","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T05:38:39Z","timestamp":1766381919000},"page":"471-481","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Low incidence of acute actionable imaging findings in emergency department patients imaged for vertigo: Retrospective analysis and proposed guidelines"],"prefix":"10.1007","volume":"33","author":[{"given":"Raven","family":"Spencer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Gandhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Tepe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Kulzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"O\u2019Neill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Eisenmenger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Goldberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aichi","family":"Chien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1308-5077","authenticated-orcid":false,"given":"Warren","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"issue":"8","key":"2426_CR1","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1111\/j.1553-2712.2008.00189.x","volume":"15","author":"KA Kerber","year":"2008","unstructured":"Kerber KA, Meurer WJ, West BT, Mark FA (2008) Dizziness presentations in U.S. emergency departments, 1995\u20132004. 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