Dizziness in the emergency department and risk of stroke: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Overall prevalence 5.5%, isolated dizziness 13.9%

• Primary Outcome: Stroke prevalence in ED dizziness patients

• Nnt Or Sensitivity: HINTS and STANDING examinations demonstrated high diagnostic accuracy for stroke detection

• Confidence Interval: Overall: 95% CI 4.1-7.1%; Isolated: 95% CI 8.2-20.9%

Clinical Application

Bedside diagnostic tools (HINTS, STANDING) are readily implementable in ED settings without additional equipment Highly relevant to Australian EDs where dizziness is a common presentation. HINTS examination aligns with RACGP guidelines for neurological assessment. Cost-effective approach may reduce unnecessary neuroimaging burden on public health system Emergency department patients presenting with dizziness, particularly those with isolated dizziness without focal neurological signs

Abstract

BACKGROUND: 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. METHODS: 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's test were employed to explore heterogeneity and publication bias. The diagnostic accuracy of bedside diagnostic tools was also systematically reviewed. RESULTS: Twenty-nine studies involving 161,013 ED patients presenting with dizziness were included. The pooled stroke prevalence among all ED dizziness patients (n = 158,583) was 5.5% (95% CI: 4.1-7.1). Among patients with isolated dizziness (n = 2,559), the pooled prevalence was 13.9% (95% CI: 8.2-20.9), 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. CONCLUSIONS: 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.

References

1. 1.Lin, H., Zhu, M., Zhang, X., & Tang, Y. (2026). Dizziness in the emergency department and risk of stroke: A systematic review and meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0346556