Evaluation of diagnostic parameters in distinguishing peripheral and central vertigo in patients admitted to the emergency department with vertigo

Objective: The aim of our study was to differentiate between peripheral and central vertigo in patients presenting to the emergency department with dizziness using bedside tests such as HINTS test, STANDING algorithm, ABCD2 score, TriAGe+ score, routine hemogram and biochemistry tests. Material and Method: The prospective-observational-cross-sectional study was conducted between 24.06.2024 - 24.04.2025 at Afyonkarahisar University of Health Sciences, Department of Emergency Medicine, Adult Emergency Department. Patients over the age of 18 who presented to the emergency department with complaints of dizziness and gave consent to participate in the study were included in the study. Demographic data of the patients, complaints of presentation, medical history, bedside tests and scoring, neurologic examination findings, vital signs, laboratory findings were recorded on the form we created. In statistical analysis, in addition to descriptive statistics, Chi-square, t test and Mann Whitney U tests were used for group comparisons. P values below 0.05 were considered statistically significant. Results: Of the 101 patients included in the study, 78 (77.2%) were peripheral vertigo and 23 (22.8%) were central vertigo. The mean age of the patients was 56.87±17.22 years. The mean age of patients with central vertigo was 69.79±9.89 years and the mean age of patients with peripheral vertigo was 52.84±17.07 years. There was a statistically significant difference in age between central and peripheral vertigo (p<0.001). A history of brain tumor (p=0.033), diabetes mellitus (DM) (p=0.001) and atrial fibrillation (AF) (p=0.016) were significant for central vertigo. A history of CVO was borderline significant (p=0.059). Alcohol use was seen in 18.2% of patients with peripheral vertigo compared to 4.2% of patients with central vertigo (p=0.036). Facial asymmetry (p=<0.001), loss of balance (p=<0.001) and loss of strength (p=<0.001) were significantly more common in patients with central vertigo than in patients with peripheral vertigo. In bedside tests, we found that STANDING algorithm showed central causes, HIT test was negative, skew test was positive and vertical nystagmus was associated with central vertigo. Among routine laboratory tests, glucose (p=0.010), C-Reactive Protein (CRP) (p=0.002) and glucose/K+ ratio (p=0.002) were significantly higher in patients with central vertigo. Albumin was lower in patients with central vertigo than in patients with peripheral vertigo (p=<0.001). Conclusion: Our study showed that advanced age, history of CVO and brain tumor, DM, CAD, AF, alcohol use, abnormal neurological examination findings, ABCD2 score, TriAGe+ score, HINTS test and STANDING algorithm, glucose level, CRP level, albumin level and glucose/K+ ratio are parameters that can be used to differentiate central and peripheral vertigo. Keywords: Perıpheral Vertigo, Central Vertigo, HINTS Test, ABCD2 Score, TriAGe+ Score