{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:00:59Z","timestamp":1792803659816,"version":"4.5.0"},"reference-count":48,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,8,17]],"date-time":"2022-08-17T00:00:00Z","timestamp":1660694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007619","name":"Society for Academic Emergency Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients presenting to the emergency department (ED) with acute vertigo or dizziness represent a diagnostic challenge. Neuroimaging has variable indications and yield. We aimed to conduct a systematic review and meta\u2010analysis of the diagnostic test accuracy of neuroimaging for patients presenting with acute vertigo or dizziness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An electronic search was designed following patient\u2013intervention\u2013control\u2013outcome (PICO) question\u2014(P) adult patients with acute vertigo or dizziness presenting to the ED; (I) neuroimaging including computed tomography (CT), CT angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and ultrasound (US); (C) MRI\/clinical criterion standard; and (O) central causes (stroke, hemorrhage, tumor, others) versus peripheral causes of symptoms. Articles were assessed in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines were followed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess certainty of evidence in pooled estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included studies that reported diagnostic test accuracy. From 6309 titles, 460 articles were retrieved, and 12 were included: <jats:italic>noncontrast <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan<\/jats:italic>\u2014six studies, 771 patients, pooled sensitivity 28.5% (95% confidence interval [CI] 14.4%\u201348.5%, moderate certainty) and specificity 98.9% (95% CI 93.4%\u201399.8%, moderate certainty); <jats:italic>MRI<\/jats:italic>\u2014five studies, 943 patients, sensitivity 79.8% (95% CI 71.4%\u201386.2%, high certainty) and specificity 98.8% (95% CI 96.2%\u2013100%, high certainty); <jats:italic>CTA<\/jats:italic>\u2014one study, 153 patients, sensitivity 14.3% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.8%\u201342.8%) and specificity 97.7% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 93.8%\u201399.6%), <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> had higher sensitivity than <jats:styled-content style=\"fixed-case\">CTA<\/jats:styled-content> (21.4% and 14.3%) for central etiology; <jats:italic>MRA<\/jats:italic>\u2014one study, 24 patients, sensitivity 60.0% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 26.2%\u201387.8%) and specificity 92.9% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 66.1%\u201399.8%); <jats:italic>US<\/jats:italic>\u2014three studies, 258 patients, sensitivity ranged from 30% to 53.6%, specificity from 94.9% to 100%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Noncontrast CT has very low sensitivity and MRI will miss approximately one in five patients with stroke if imaging is obtained early after symptom onset. The evidence does not support neuroimaging as the only tool for ruling out stroke and other central causes in patients with acute dizziness or vertigo presenting to the ED.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14561","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T10:38:47Z","timestamp":1658745527000},"page":"517-530","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta\u2010analysis for the guidelines for reasonable and appropriate care in the emergency department"],"prefix":"10.1111","volume":"30","author":[{"given":"Vishal Paresh","family":"Shah","sequence":"first","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5388-9163","authenticated-orcid":false,"given":"Lucas","family":"Oliveira J. e Silva","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Emergency Medicine Hospital de Cl\u00ednicas de Porto Alegre  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wigdan","family":"Farah","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Seisa","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdalla","family":"Kara Balla","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"April","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Community Internal Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdoleen","family":"Farah","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashar","family":"Hasan","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1632-4750","authenticated-orcid":false,"given":"Fernanda","family":"Bellolio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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