老年人因眩晕至急诊就诊后30天内非计划急性住院的诊断谱：一项全省范围的回顾性队列研究

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中文摘要

背景： 眩晕是急诊科（ED）就诊的常见原因，其评估通常以排除卒中为主要关注点。然而，老年人眩晕就诊后更广泛的严重诊断谱仍未被充分描述。我们旨在描述65岁及以上因眩晕至急诊就诊的患者中30天住院情况，特别关注卒中以外的诊断。
方法： 这项全省范围的回顾性队列研究纳入了2024年1月至2025年12月期间在土耳其吉雷松17家急诊科就诊、具有眩晕相关ICD-10编码的年龄≥65岁患者。ICD-10编码被用作初步病例发现策略，最终分析仅纳入经临床病历审查确认眩晕为主要主诉的患者。根据入院时间对患者进行分类；对临床特征、影像学使用、风险评分和最终诊断进行描述性总结，并进行探索性组间比较。
结果： 在通过眩晕相关ICD-10编码识别的6,460名老年人中，269人在索引就诊后30天内经急诊科发生非计划急性住院。经临床病历审查后，186名以眩晕为主要主诉的患者被纳入最终分析。研究队列的平均年龄为75.9±7.2岁，106名患者（57.0%）为男性。70名患者（37.6%）在索引急诊就诊期间入院，而116名（62.4%）在急诊离院后入院。神经系统急症占84例入院（45.2%），其中74例（占队列总数的39.8%）为卒中。在急诊离院后发生的116例入院中，79例（68.1%）归因于卒中以外的诊断，包括71例（61.2%）由非神经系统疾病所致，最常见的是代谢/肾脏、感染和心脏疾病。
结论： 在因眩晕至急诊就诊后30天内入院的老年人中，非神经系统诊断占急诊离院后住院的相当大比例。这些发现描述的是一个以住院为条件的队列的诊断谱，不应被解释为总体入院风险或诊断准确性的估计。

英文摘要

BACKGROUND: Vertigo is a common reason for emergency department (ED) attendance and is frequently evaluated with a primary focus on excluding stroke. However, the broader spectrum of serious diagnoses following vertigo presentation in older adults remains insufficiently characterized. We aimed to characterize 30-day hospital admissions among patients aged 65 years and older presenting to the ED with vertigo, with particular attention to diagnoses beyond stroke.
METHODS: This province-wide retrospective cohort study included patients aged ≥65 years presenting to 17 EDs in Giresun, Türkiye, with vertigo-related ICD-10 codes between January 2024 and December 2025. ICD-10 coding was used as an initial case-finding strategy, and only patients in whom vertigo was confirmed as the dominant presenting complaint after clinical record review were included in the final analysis. Patients were categorized according to admission timing; clinical characteristics, imaging use, risk scores, and final diagnoses were summarized descriptively, with exploratory between-group comparisons.
RESULTS: Among 6,460 older adults identified through vertigo-related ICD-10 codes, 269 had an unplanned acute hospital admission through an ED within 30 days after the index visit. After clinical record review, 186 patients with vertigo as the dominant presenting complaint were included in the final analysis. The mean age of the study cohort was 75.9 ± 7.2 years, and 106 patients (57.0%) were male. Seventy patients (37.6%) were admitted during the index ED visit, whereas 116 (62.4%) were admitted after ED discharge. Neurological emergencies accounted for 84 admissions (45.2%), of which 74 (39.8% of the total cohort) were strokes. Among the 116 admissions occurring after ED discharge, 79 (68.1%) were attributable to diagnoses other than stroke, including 71 (61.2%) due to non-neurological conditions, most commonly metabolic/renal, infectious, and cardiac disorders.
CONCLUSION: Among older adults admitted within 30 days after an ED presentation with vertigo, non-neurological diagnoses constituted a substantial proportion of hospitalizations after ED discharge. These findings describe the diagnostic spectrum of a hospitalization-conditioned cohort and should not be interpreted as estimates of overall admission risk or diagnostic accuracy.