Written by Shannon Markus
Spoon Feed
The Sudbury Vertigo Risk Score was validated in a new cohort and accurately identified patients as low risk, not requiring further investigation, or needing treatment for a serious diagnosis of vertigo.
Verti-GO home – a safe discharge never felt so good
The developers of the Sudbury Vertigo Risk Score aimed to validate the tool in an entirely new cohort of ED patients with dizziness. Given the lack of reliable clinical features to exclude serious causes of dizziness, this chief complaint often leads to overuse of neurologic imaging and delayed or missed diagnoses of stroke, TIA, or brain tumors. This retrospective multi-center study was conducted in three Canadian tertiary care EDs from 2014-2020, enrolling 4,559 patients (mean age 78.1 years, 57.8% women). Serious diagnoses occurred in 104 (2.3%) patients. The risk score stratified patients from 0% risk (score <5) to 16.7% (score >8).
For scores <5, the risk of a serious outcome was 0%, with a sensitivity for a serious diagnosis of 100% (95%CI 96.5%-100%) and a specificity of 69.2% (95%CI 67.8%-70.51%). Patients scoring 5-8 had a 0.9% risk, while scores >7 had 100% sensitivity (95%CI 94%-100%) and 84.2% specificity (95%CI 83.1%-85.2%) for positive CT findings. The tool offers a posttest probability of <0.5% for serious outcomes – below the 1% miss rate often accepted in emergency medicine – supporting its use for safe discharge and cost-effective care. Limitations include the lack of external validation sites, which may impact generalizability.
How will this change my practice?
This user-friendly tool appears to accurately identify dizzy patients at low risk who can be safely discharged without further investigation and for triaging patients with higher risk. This may improve outcomes, minimize missed diagnoses, and reduce unnecessary costs. I hope to see this study validated elsewhere, especially the southern U.S., where the prevalence of CV risk factors and stroke is likely higher than in this study population. Dizziness is my most abhorred complaint (followed closely by “There are parasites in my fingers”), so I’m keeping my eyes peeled for more developments in this space.
Editor’s Note: It would seem that this study and the derivation study had overlapping data sets. Do not count this as an external validation. ~Nick Zelt
Source
Validation of the Sudbury Vertigo Risk Score to risk stratify for a serious cause of vertigo. Acad Emerg Med. 2025 Mar 11. doi: 10.1111/acem.70017. Epub ahead of print. PMID: 40070159
