"Approccio diagnostico ai pazienti con vertigini in un DEA di III livello"

Abstract Introduction Dizziness is a frequent reason for presentation to the Emergency Department (ED); however, its clinical manifestations may conceal a time-dependent central etiology, namely posterior circulation stroke (PCS). The aim of this thesis is to evaluate the ability of the ED—ranging from nursing triage to physician assessment—to identify patients whose symptom constellation and risk factors (past medical history, sex, age, smoking status) require priority evaluation. Methods A retrospective, observational, single-center study was conducted, including adult patients presenting to the Emergency Department of the Azienda Ospedaliera di Padova (AOPD) with a triage label of “dizziness,” either isolated or associated with other symptoms. Patients with hemodynamic instability were excluded. A total of 559 patients were enrolled between March and July 2025. The primary endpoint was the number of patients diagnosed with posterior circulation stroke for whom the stroke protocol was activated, as well as the timing of neurological consultation in relation to otorhinolaryngology (ENT) assessment. Results Central causes of dizziness were rare (9 cases, 1.6%). All patients with central nervous system pathology underwent either brain computed tomography or neurological evaluation as the initial diagnostic assessment. No stroke protocol was activated, and no revascularization treatments (thrombolysis or thrombectomy) were performed. No discharged patient experienced major neurological events upon return to the Emergency Department. The distinction between objective and subjective vertigo proved unreliable for risk stratification, whereas the presence of atrial fibrillation and the detection of ataxia or diplopia were more strongly associated with a central etiology. A significant degree of inter-operator variability emerged in the assessment of nystagmus. Conclusions Dizziness remains a diagnostic challenge for the Emergency Physician; however, a systematic approach and the adoption of validated clinical algorithms (HINTS, STANDING) may further improve diagnostic accuracy in the Emergency Department

Le vertigini sono un motivo frequente di accesso in Pronto Soccorso, tuttavia i suoi sintomi possono mascherare un’eziologia centrale il cui trattamento è tempo-dipendente: l’ictus del circolo posteriore (ICP). Scopo di questa tesi è valutare la capacità del PS (dal Triage infermieristico alla valutazione del Medico) di intercettare quei pazienti il cui corteo sintomatologico e i fattori di rischio (anamnesi patologica, sesso, età, fumo) richiedono una valutazione prioritaria. Lo studio è di tipo retrospettivo, osservazionale, monocentrico e ha reclutato pazienti maggiorenni che accedevano al Pronto Soccorso dell’Azienda Ospedaliera di Padova con una scheda di Triage “Vertigini”, anche in associazione ad altri sintomi, ad esclusione di chi presentava un’instabilità emodinamica. L’endpoint primario ha valutato il numero di pazienti, con diagnosi di ICP, per i quali è stato attivato il protocollo stroke ed inoltre con quale tempistica è stata richiesta la valutazione neurologica (se prima o dopo la visita ORL).