TOPLINE:

In adults discharged home after an emergency department visit for dizziness, the 30-day incidence of stroke with disability or death was very low — approximately 1 in 2500 patients.

METHODOLOGY:

• Researchers conducted a retrospective study of 77,315 patients (median age, 59 years; 62% women; 43% Hispanic, 30% White, and 12% Black individuals) who presented to the ED with dizziness between 2016 and 2020 and were discharged home. A head CT was performed in 34% and MRI in 10% of patients at the index visit.
• Dizziness was defined as having either a primary ED discharge diagnosis of dizziness (International Classification of Diseases, Tenth Revision code), a vestibular disorder, or a related diagnosis or having dizziness recorded as the chief complaint at triage.
• The primary outcomes were stroke hospitalization and stroke-related mortality or disability. Stroke hospitalization was defined as a subsequent hospitalization with a primary stroke diagnosis.
• Secondary outcomes included indicators of stroke severity, such as thrombolysis, thrombectomy, mechanical ventilation, craniectomy, and gastrostomy tube placement.

TAKEAWAY:

• Within 30 days, 0.12% of patients were hospitalized for a stroke, corresponding to about 1 in 830 patients, and the cumulative incidence of stroke with disability or death was 0.04%, corresponding to about 1 in 2500 patients.
• Among patients who experienced a stroke, 1% received thrombolytics, and 5% underwent thrombectomy as part of acute treatment.
• The frequencies of stroke complication management procedures were 2% for suboccipital craniectomy, 3% for tracheostomy, 3% for gastrostomy, and 10% for mechanical intubation.
• Most lesions (55%) were in the anterior fossa on imaging, and 78% were ischemic. Among patients with a documented modified Rankin scale score or death at the time of stroke hospitalization (n = 80), 53% of the survivors retained the ability to walk independently at discharge.

IN PRACTICE:

"In conclusion, the cumulative incidence of stroke hospitalization with disability/mortality for patients discharged from the ED to home after an ED dizziness visit is very low," the authors wrote. "These data are important for contextualizing efforts to optimize outcomes of patients presenting to the ED for dizziness," they added.

SOURCE:

The study was led by Kevin Kerber, MD, MS, The Ohio State University, Columbus, Ohio. It was published online on November 18, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The retrospective study design and potential population bias limited generalizability. Stroke detection could have been influenced by relatively high MRI use (10%) at this center compared with lower MRI utilization at other facilities. Later events were not captured.

DISCLOSURES:

The study was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.