{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:10:17Z","timestamp":1793725817221,"version":"4.6.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population.\u00a0This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of\u2009&gt;\u200965\u00a0years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65\u00a0years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.<\/jats:p>","DOI":"10.1038\/s41598-021-85725-1","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T07:03:33Z","timestamp":1615964613000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Stroke prediction in patients presenting with isolated dizziness in the emergency department"],"prefix":"10.1038","volume":"11","author":[{"given":"June-sung","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Jun","family":"Bae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muyeol","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Hwan","family":"Sohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Woo","family":"Seo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"85725_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1159\/000481982","volume":"79","author":"M Ljunggren","year":"2018","unstructured":"Ljunggren, M., Persson, J. & Salzer, J. Dizziness and the acute vestibular syndrome at the emergency department: A population-based descriptive study. Eur. Neurol. 79, 5\u201312 (2018).","journal-title":"Eur. Neurol."},{"key":"85725_CR2","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.1001\/archinte.168.19.2118","volume":"168","author":"HK Neuhauser","year":"2008","unstructured":"Neuhauser, H. K. et al. Burden of dizziness and vertigo in the community. Arch. Intern. Med. 168, 2118\u20132124 (2008).","journal-title":"Arch. Intern. Med."},{"key":"85725_CR3","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1001\/archinternmed.2009.333","volume":"169","author":"GD Schiff","year":"2009","unstructured":"Schiff, G. D. et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch. Intern. Med 169, 1881\u20131887 (2009).","journal-title":"Arch. Intern. Med"},{"key":"85725_CR4","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1515\/dx-2013-0038","volume":"1","author":"DE Newman-Toker","year":"2014","unstructured":"Newman-Toker, D. E., Moy, E., Valente, E., Coffey, R. & Hines, A. L. Missed diagnosis of stroke in the emergency department: A cross-sectional analysis of a large population-based sample. Diagnosis (Berl) 1, 155\u2013166 (2014).","journal-title":"Diagnosis (Berl)"},{"key":"85725_CR5","doi-asserted-by":"publisher","first-page":"765","DOI":"10.4065\/83.7.765","volume":"83","author":"DE Newman-Toker","year":"2008","unstructured":"Newman-Toker, D. E. et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin. Proc. 83, 765\u2013775 (2008).","journal-title":"Mayo Clin. Proc."},{"key":"85725_CR6","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1212\/WNL.0000000000003814","volume":"88","author":"AA Tarnutzer","year":"2017","unstructured":"Tarnutzer, A. A. et al. ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: A meta-analysis. Neurology 88, 1468\u20131477 (2017).","journal-title":"Neurology"},{"key":"85725_CR7","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1111\/acem.12168","volume":"20","author":"AS Saber Tehrani","year":"2013","unstructured":"Saber Tehrani, A. S. et al. Rising annual costs of dizziness presentations to U.S. emergency departments. Acad. Emerg. Med. 20, 689\u2013696 (2013).","journal-title":"Acad. Emerg. Med."},{"key":"85725_CR8","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1136\/emj.2009.078014","volume":"27","author":"CS Cheung","year":"2010","unstructured":"Cheung, C. S. et al. Predictors of important neurological causes of dizziness among patients presenting to the emergency department. Emerg. Med. J 27, 517\u2013521 (2010).","journal-title":"Emerg. Med. J"},{"key":"85725_CR9","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1161\/STROKEAHA.110.594630","volume":"42","author":"LR Caplan","year":"2011","unstructured":"Caplan, L. R. Stroke classification: A personal view. Stroke 42, S3-6 (2011).","journal-title":"Stroke"},{"key":"85725_CR10","doi-asserted-by":"publisher","first-page":"124","DOI":"10.5853\/jos.2014.16.3.124","volume":"16","author":"H Lee","year":"2014","unstructured":"Lee, H. Isolated vascular vertigo. SJ. Stroke 16, 124\u2013130 (2014).","journal-title":"SJ. Stroke"},{"key":"85725_CR11","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1212\/01.wnl.0000238500.02302.b4","volume":"67","author":"H Lee","year":"2006","unstructured":"Lee, H. et al. Cerebellar infarction presenting isolated vertigo: Frequency and vascular topographical patterns. Neurology 67, 1178\u20131183 (2006).","journal-title":"Neurology"},{"key":"85725_CR12","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1016\/j.mayocp.2012.05.023","volume":"87","author":"BB Navi","year":"2012","unstructured":"Navi, B. B. et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin. Proc. 87, 1080\u20131088 (2012).","journal-title":"Mayo Clin. Proc."},{"key":"85725_CR13","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1136\/emj.2010.104844","volume":"29","author":"KA Kerber","year":"2012","unstructured":"Kerber, K. A. et al. Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study. Emerg. Med. J. 29, 43\u201346 (2012).","journal-title":"Emerg. Med. J."},{"key":"85725_CR14","first-page":"288","volume":"34","author":"E Armato","year":"2014","unstructured":"Armato, E., Ferri, E., Pinzani, A. & Ulmer, E. Cerebellar haemorrhage mimicking acute peripheral vestibulopathy: The role of the video head impulse test in differential diagnosis. Acta Otorhinolaryngol. Ital. 34, 288\u2013291 (2014).","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"85725_CR15","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.1161\/hs1201.100209","volume":"32","author":"PL Kolominsky-Rabas","year":"2001","unstructured":"Kolominsky-Rabas, P. L., Weber, M., Gefeller, O., Neundoerfer, B. & Heuschmann, P. U. Epidemiology of ischemic stroke subtypes according to TOAST criteria: Incidence, recurrence, and long-term survival in ischemic stroke subtypes: A population-based study. Stroke 32, 2735\u20132740 (2001).","journal-title":"Stroke"},{"key":"85725_CR16","doi-asserted-by":"publisher","first-page":"2549","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.06.038","volume":"25","author":"R Doijiri","year":"2016","unstructured":"Doijiri, R., Uno, H., Miyashita, K., Ihara, M. & Nagatsuka, K. How commonly is stroke found in patients with isolated vertigo or dizziness attack?. J. Stroke Cerebrovasc. Dis. 25, 2549\u20132552 (2016).","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"85725_CR17","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1212\/WNL.0000000000000573","volume":"83","author":"AS Saber Tehrani","year":"2014","unstructured":"Saber Tehrani, A. S. et al. Small strokes causing severe vertigo: Frequency of false-negative MRIs and nonlacunar mechanisms. Neurology 83, 169\u2013173 (2014).","journal-title":"Neurology"},{"key":"85725_CR18","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.4065\/82.11.1319","volume":"82","author":"VA Stanton","year":"2007","unstructured":"Stanton, V. A. et al. Overreliance on symptom quality in diagnosing dizziness: Results of a multicenter survey of emergency physicians. Mayo Clin. Proc. 82, 1319\u20131328 (2007).","journal-title":"Mayo Clin. Proc."},{"key":"85725_CR19","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.ajem.2011.02.002","volume":"30","author":"M Chase","year":"2012","unstructured":"Chase, M. et al. ED patients with vertigo: Can we identify clinical factors associated with acute stroke?. Am. J. Emerg. Med. 30, 587\u2013591 (2012).","journal-title":"Am. J. Emerg. Med."},{"key":"85725_CR20","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.mayocp.2013.10.026","volume":"89","author":"M Chase","year":"2014","unstructured":"Chase, M. et al. A prospective pilot study of predictors of acute stroke in emergency department patients with dizziness. Mayo Clin. Proc. 89, 173\u2013180 (2014).","journal-title":"Mayo Clin. Proc."},{"key":"85725_CR21","doi-asserted-by":"publisher","first-page":"2435","DOI":"10.1161\/STROKEAHA.120.028992","volume":"51","author":"C Flach","year":"2020","unstructured":"Flach, C., Muruet, W., Wolfe, C. D. A., Bhalla, A. & Douiri, A. Risk and secondary prevention of stroke recurrence: A population-base cohort study. Stroke 51, 2435\u20132444 (2020).","journal-title":"Stroke"},{"key":"85725_CR22","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","volume":"24","author":"HP Adams Jr","year":"1993","unstructured":"Adams, H. P. Jr. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24, 35\u201341 (1993).","journal-title":"Stroke"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85725-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85725-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85725-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T00:25:38Z","timestamp":1670027138000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-85725-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["85725"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-85725-1","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-118052\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"29 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6114"}}