Tansu AKPINAR, Şerife ÖZDİNÇ
Eurasian Journal of Emergency Medicine - 2026;25(1):254-260
Aim: This study aims to differentiate peripheral from central vertigo in patients presenting to the emergency department (ED) with complaints of dizziness, using medical history, physical examination, bedside tests, and blood tests. Materials and Methods: This prospective, observational, cross-sectional study was conducted in the Adult ED at the Afyonkarahisar Health Sciences University Faculty of Medicine between June 24, 2024, and April 24, 2025. Patients aged 18 years and older who presented to the ED with complaints of dizziness and who consented to participate in the study were included. Data on patient demographics, presenting complaints, medical history, bedside test results and scores, neurological examination findings, vital signs, and laboratory results were recorded on a form. Descriptive statistics were used in addition to Chi-square tests, t-tests, and Mann-Whitney U tests for group comparisons. Values with a p-value below 0.05 were considered statistically significant. Results: Peripheral vertigo was present in 77.2% (n=78) of the 101 patients included in the study. The mean age of patients with central vertigo was 69.79+/-9.89 years, while the mean age of patients with peripheral vertigo was 52.84+/-17.07 years (p<0.001). Central vertigo was significantly more prevalent among patients with a history of brain tumors (p=0.033), diabetes mellitus (DM) (p=0.001), and atrial fibrillation (AF) (p=0.016). Conversely, peripheral vertigo was significantly more prevalent among patients with a history of alcohol use (p=0.036). We found that in patients with central vertigo, the STANDING algorithm showed central causes at a significant rate; the head impulse test was negative, the skew test was positive, and vertical nystagmus accompanied it (p<0.001). Laboratory tests showed that levels of glucose (p=0.010), C-reactive protein (CRP) (p=0.002), and the glucose-to-K+ ratio (p=0.002) were significantly higher in patients with central vertigo. Albumin levels were lower in patients with central vertigo than in those with peripheral vertigo (p<0.001). Conclusion: The study found that advanced age, acute cerebrovascular accident, brain tumor, DM, AF, history of alcohol use, neurological examination findings, ABCD2, TriAGe+ score, head impulse, nystagmus, test of skew test, and STANDING algorithm, blood glucose, CRP, albumin level, and glucose/K+ ratio as parameters that can be used to differentiate between central and peripheral vertigo.
