Abstract TP260: Causes of Delayed Diagnosis of Vertebrobasilar Stroke Patients After Arrival at Emergency Room

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Introduction: Dizziness is a main symptom caused by ischemic insult to vertebrobasilar vessels as well as peripheral vertigo. So, proper diagnosis and management is often delayed in the vertebrobasilar ischemic patients. The present study was to evaluate factors related with the delayed diagnosis among vertebrobasilar infarction patients suffered from dizziness as initial main symptom.Methods: We reviewed clinical and radiologic data of 166 patients, who suffered from dizziness and/or vertigo as initial symptom and diagnosed finally as acute infarction on cerebellum and/or brainstem. First, we classified patients by incorrect triage as peripheral vertigo for the patients by first triage doctor of emergency room. Then, we evaluated time intervals from arrival at emergency room to first examination by a neurologist, to first brain image, and to final diagnosis as ischemic stroke of each group of patients. Type of initial symptoms including dizziness only or dizziness plus focal neurologic deficits were also compared between the groups. Finally, factors related with the incorrect triage of the included patients were analyzed using multivariate analysis.Results: The time from ER arrival to examination by a neurologist (221.0±158.7 vs. 56.0±76.8 min, p<0.001), to first image (232.4±182.1 vs. 58.2±77.0 min, p<0.001), and to final diagnosis (367.2±179.7 vs. 151.3±94.1 min, p<0.001) were significantly delayed in incorrect triage group. More patients in incorrect triage group showed dizziness only at presenting ER (52% vs. 13%, p<0.001). Among the focal neurologic signs defined by neurologists in incorrect triage group, Tandem abnormality was most frequently observed (29%). On multiple regression analysis, presence of chronic kidney disease (Odd ratio (OR) 15.7, 95% CI 1.4-175.6, p=0.026), isolated dizziness symptom (OR 13.5, 95% CI 3.3-55.3, p<0.001).Conclusions: In the present study, presence of chronic kidney disease and initial presenting symptom were the main cause of delaying diagnosis of vertebrobasilar infarction patients in ER. Additionally, Tandem gait should be performed for the dizzy patients to avoid delaying diagnosis of ischemic stroke.

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