Cumulative Incidence of Stroke Disability and Mortality After ED Discharge for Dizziness: A Cohort Study

Cumulative Incidence of Stroke Disability and Mortality After ED Discharge for Dizziness: A Cohort Study

Authors: Kerber KA, Sangha N, Burke JF, Jancis MO, Baecker A, Shen E, Nguyen H, Monjazeb S, Manthena P, Park S, Sharp AL, Meurer WJ

Journal: Annals of Emergency Medicine, November 2025

Conclusions:

  • After an ED dizziness visit with discharge home, 30-day stroke causing death or significant disability is rare (~0.04%; ~1 in 2,500).

  • Overall 30-day stroke hospitalization is very low (~0.12%; ~1 in 830).

  • Since only a subset of subsequent strokes are likely related to the index visit, true “missed stroke” leading to severe outcomes is probably even lower.

  • Most subsequent strokes were anterior circulation, not the posterior events we often worry about in dizzy patients.

Results:

  • Setting: Kaiser Permanente Southern California, 2016–2020.

  • 77,315 adult ED dizziness discharges analyzed.

  • 30-day outcomes:

    • Stroke hospitalization: 0.12% (95% CI 0.10–0.15; n=94).

    • Stroke hospitalization with disability/mortality (discharged to any setting other than home): 0.04% (95% CI 0.03–0.06; n=33).

  • Imaging location among subsequent strokes: 59% anterior fossa (55/94).

  • Acute interventions among subsequent strokes (n=94):

    • Thrombolytics 1% (1); thrombectomy 5% (5).

    • Suboccipital craniotomy 2% (2); tracheostomy 3% (3); gastrostomy 3% (3); mechanical intubation 10% (9).

Methods:

  • Retrospective cohort of adult ED dizziness visits discharged home.

  • 30-day follow-up for stroke hospitalization and for stroke with disability/mortality (proxy: any disposition other than home).

  • Kaplan–Meier to estimate cumulative incidence; summarized acute stroke care and lesion location on imaging.

Kerber KA, Sangha N, Burke JF, Jancis MO, Baecker A, Shen E, Nguyen H, Monjazeb S, Manthena P, Park S, Sharp AL, Meurer WJ. Cumulative Incidence of Stroke Disability and Mortality Following Emergency Department Discharge for Dizziness: A Cohort Study. Ann Emerg Med. 2025 Nov 18:S0196-0644(25)01244-2. doi: 10.1016/j.annemergmed.2025.09.029. Epub ahead of print. PMID: 41258854.

 

Back to blog