| BackgroundDizziness, a subjective feeling which is often onset acute, lasting longor short and attacking repeatedly. The morbidity rate of dizziness is veryhigh. Its pathogenesis involves many subjects, such as neurology,otorhinolaryngology, psychiatry, cardiology and so on. Dizziness is themain reason of neurology outpatient. Because of varied causes, similarfeature and the poor recognition of clinicians, it is difficult to diagnosis andtreat the dizziness. At the same time over-examine springs up. It aggravatesthe economic burden of patients and wastes medical resources. Majority ofdizziness were not caused by serious illness, but the discomfort and fatiguecaused by dizziness seriously affect the work and life of sufferers. What’smore, dizziness may be the initial or only symptom of severe even fataldisease in few patients, especially in central vestibular lesions which isneeded emergency treatment because time means brain. Accurateidentification of dizzy patients may lead to appropriate timely intervention that can minimize stroke-related damage and can choose the mostappropriate individual therapy.The ABCD~2score is a simple, validated, and widely applied clinicalprediction tool for assessing the risk of stroke after transient ischemicattack (TIA). It is ranging from0to7, which assigns points based on thefollowing5clinical factors: age, blood pressure, clinical features, durationof symptoms and diabetes. The score is recognized as a useful model forassessment after TIA stroke risk. Foreign scholars uesed ABCD~2score toidentify cerebrovascular causes of dizziness in Emergency Department(ED).We evaluated the stroke diagnostic value of the ABCD~2score in patientswith dizziness in the Department of Neurology.PurposeThe research aims to observe the general condition, vascular riskfactors in patients with dizziness and differences of ABCD~2score betweenpatients with stroke and patients without stroke. We evaluate whetherABCD~2score can discriminate between patients with stroke and those withother diagnoses.MethodsWe conducted a retrospective case-control observational study. Weidentified consecutive adults with a chief symptom of dizziness, vertigo, orimbalance presenting to the Department of Neurology in the First AffiliatedHospital of Chongqing Medical University from March2011to March 2012. The First Affiliated Hospital of Chongqing Medical University is atertiary care hospital. Eligible patients were identified using a free-textsearch of presenting triage symptoms for the following terms: dizzy,dizziness, vertigo, spinning, imbalance and the symptom onset within72hours. Medical records were collected by predesigned EXCEL form,recording the patient’s gender, age, chief complaint, the main symptoms,accompanied by symptoms, duration of symptoms, blood pressure onadmission, past medical history (hypertension, diabetes, coronary heartdisease, high cholesterol, atrial fibrillation, smoking, drinking, previousstroke history), imaging scan (CT, MRI, vascular imaging), laboratory tests(blood lipids, etc.), carotid ultrasonography, nervous system signs,discharge diagnosis. ABCD~2scores were then assigned by using clinicalinformation from the medical record. The stroke only refers to cerebralinfarction and cerebral hemorrhage, not including lacunar infarction in thisresearch. According to the final discharge diagnosis, the patients weredivided into two groups, the stroke group and the non-stroke group. Duringthe2-year study period, there were964patients with a triage symptom ofdizziness or a related search term. Statistical analyses were performed withSPSS (version17.0). P value<0.05was considered as significant. The dataof two groups was compared by Chi-square examination andMann-Whitney U test. The areas under the receiver-operator curves and95%confidence intervals were then generated to estimate the diagnostic value.ResultsThere were403patients met our eligibility criteria and were includedin the final analysis.76(18.86%) had a cerebrovascular cause, of which61were ischemic strokes, and15were intracerebral hemorrhages. Comparedto patients without stroke, patients with stroke were typically male, hadhistory of hypertension, high blood pressure and higher ABCD~2score.ABCD~2score≥5are more likely a diagnosis of stroke.Conclusions1. Dizziness occurs in middle-aged and old patients, incidence ofwomen was higher than men. Hypertension and dyslipidemia are thecommon risk factors.2. Male, hypertension, high blood pressure on admission are morelikely to prompt that dizziness is caused by cerebrovascular disease.3. ABCD~2score5points or more risk factors can help clinical doctorsscreening dizziness of cerebrovascular events.4. ABCD~2score method helps to quickly identify dizziness in patientswith cerebrovascular disease. |
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