{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:40:29Z","timestamp":1790300429887,"version":"4.1.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dizziness is a frequent emergency department (ED) presentation, and a subset of patients, especially those with isolated dizziness without focal neurological deficits, have stroke but are prone to misdiagnosis and adverse outcomes. Reported stroke prevalence in ED dizziness cohorts is highly heterogeneous, and comprehensive assessments of isolated dizziness remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, we systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for relevant studies. We included cross-sectional studies reporting stroke prevalence among all ED patients with dizziness or isolated dizziness. A random-effects model was used for meta-analysis to calculate pooled prevalence. Subgroup analyses and Egger\u2019s test were employed to explore heterogeneity and publication bias. The diagnostic accuracy of bedside diagnostic tools was also systematically reviewed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-nine studies involving 161,013 ED patients presenting with dizziness were included. The pooled stroke prevalence among all ED dizziness patients (n\u2009=\u2009158,583) was 5.5% (95% CI: 4.1\u20137.1). Among patients with isolated dizziness (n\u2009=\u20092,559), the pooled prevalence was 13.9% (95% CI: 8.2\u201320.9), substantially higher than in the overall dizziness cohort. Subgroup analyses indicated diagnostic methods and hospital level as major contributors to heterogeneity. Summary analysis of bedside diagnostic tools showed that HINTS and STANDING examinations have high diagnostic accuracy overall, while the TriAGe+ score can be applied flexibly for screening or confirmation based on different cut-off points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ED patients with dizziness carry a meaningful, setting-dependent stroke risk. Standardized bedside exams (HINTS, STANDING) improve early triage, and selectively deploying neuroimaging helps prevent missed strokes when risk is high.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346556","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T17:29:21Z","timestamp":1775669361000},"page":"e0346556","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dizziness in the emergency department and risk of stroke: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"given":"Haiyan","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meier","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4292-5691","authenticated-orcid":true,"given":"Yanliang","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"issue":"11","key":"pone.0346556.ref001","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.4065\/82.11.1329","article-title":"Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting","volume":"82","author":"DE Newman-Toker","year":"2007","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"pone.0346556.ref002","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1001\/jamaneurol.2022.4531","article-title":"Prevalence of neurological complaints in US emergency departments, 2016-2019","volume":"80","author":"AL Liberman","year":"2023","journal-title":"JAMA Neurol"},{"issue":"1","key":"pone.0346556.ref003","first-page":"33","article-title":"China stroke surveillance report 2021","volume":"10","author":"Special Writing Group of China Stroke Surveillance","year":"2023","journal-title":"Mil Med Res"},{"issue":"1","key":"pone.0346556.ref004","first-page":"46","article-title":"Epidemiological trends of subarachnoid hemorrhage at global, regional, and national level: a trend analysis study from 1990 to 2021","volume":"11","author":"B Lv","year":"2024","journal-title":"Mil Med Res"},{"issue":"1","key":"pone.0346556.ref005","first-page":"26","article-title":"N-terminal pro-brain natriuretic peptide - 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