Out-of-hospital scaling to recognize central vertigo.

OBJECTIVE: To determine parameters that could assist emergency medical services (EMS) or triage personnel in identifying patients with central vertigo (cerebellar stroke). METHODS: The medical records at a university-based emergency department (ED) were retrospectively analyzed. The study patients comprised of 23 patients who were transported by EMS between April 2011 and March 2012 with a chief complaint of vertigo. We reviewed their medical records, including their symptoms, vital signs, review of systems, and past medical histories, to identify several parameters that could be used by paramedics to recognize central vertigo (cerebellar stroke). RESULTS: Of the 23 patients, 4 had central vertigo (2 had cerebellar infarction and 2 had cerebellar hemorrhage) and 19 had peripheral vertigo. High blood pressure and lack of horizontal component of nystagmus were found to be good predictors of central vertigo (cerebellar stroke) in these patients. Using a systolic blood pressure of more than 160 mmHg and lack of horizontal component of nystagmus as parameters, we can predict central vertigo (cerebellar stroke) with 100% sensitivity, 84% specificity, 57% positive predictive value and 100% negative predictive value (P = 0.0035). CONCLUSION: Using limited sample data, high blood pressure and lack of horizontal component of nystagmus were identified as good out-of-hospital parameters that could be used by paramedics to recognize central vertigo (cerebellar stroke).