Acil serviste akut vertigoda inme öngörüsü için TriAGe+ ve Sudbury skorlarının karşılaştırılması: Retrospektif bir analiz

Öz

Amaç: Akut baş dönmesi, acil serviste sık karşılaşılan bir başvuru nedeni olup, inme klinik açıdan son derece önemli bir etiyolojidir ve tanısal açıdan önemli bir zorluk oluşturmaktadır. Bu çalışmada, baş dönmesi ile acil servise başvuran hastalarda inme öngörüsünde TriAGe+ ve Sudbury skorlarının tanısal performanslarının karşılaştırılması amaçlandı. Gereç ve Yöntemler: Bu tek merkezli, retrospektif kohort çalışmaya 2020–2025 yılları arasında baş dönmesi şikayeti ile başvuran 256 erişkin hasta dahil edildi (128 stroke, 128 non-stroke). Primer sonlanım noktası, baş dönmesi ile başvuran hastalarda inmenin öngörülmesinde TriAGe+ ve Sudbury skorlarının tanısal performanslarının karşılaştırılmasıydı. Tanısal performanslar, alıcı işletim karakteristik (ROC) analizi ile değerlendirildi ve DeLong testi kullanılarak karşılaştırıldı. Bulgular: TriAGe+ skoru, Sudbury skoruna kıyasla daha yüksek tanısal performans gösterdi (AUC 0,898 vs. 0,837; ΔAUC = 0,061; p = 0,005). Optimal kesme değeri ≥7 olarak belirlendi ve bu kesme değerinde, TriAGe+ için duyarlılık %75,0 (95% CI: 66,6–82,2) ve özgüllük %83,6 (95% CI: 76,0–89,5) iken, Sudbury skoru için sırasıyla %78,9 (95% CI: 70,8–85,6) ve %74,2 (95% CI: 65,7–81,5) olarak saptandı. TriAGe+ skorunun 5 kesme değerinde negatif olabilirlik oranının (LR−) 0,09 (95% CI: 0,04–0,18) olması nedeniyle dışlama gücü daha yüksekti; ayrıca 10 kesme değerinde %100 (95% CI: 97,2–100,0) özgüllük ve %100 (95% CI: 92,6–100,0) pozitif prediktif değer ile tanısal kesinliği daha yüksekti. Sonuç: TriAGe+ skoru, akut baş dönmesi ile acil servise başvuran hastalarda inme öngörüsünde Sudbury skorundan daha iyi performans göstermiştir. Çok yüksek risk eşiğindeki TriAGe+ skoru, kohortumuzda inme için iyi bir tanısal doğruluk sergilemiştir. Bu bulguların rutin klinik kullanıma girmeden önce prospektif acil servis popülasyonlarında dış doğrulaması gerekmektedir.

Anahtar Kelimeler

• Acil servis
• baş dönmesi
• inme
• Sudbury
• TriAGe+
• vertigo

Destekleyen Kurum

Yazarlar, çalışmanın herhangi bir finansman almadığını beyan eder.

Etik Beyan

Çalışma, Karadeniz Teknik Üniversitesi Tıp Fakültesi Bilimsel Araştırmalar Etik Kurulu tarafından onaylandı (tarih: 18.02.2026, sayı: 2026/42). Çalışma, Helsinki Bildirgesi ilkelerine uygun olarak yürütüldü. Anonimleştirilmiş hasta kayıtlarına dayanan retrospektif bir çalışma olması nedeniyle, bilgilendirilmiş onam gerekliliği etik kurul tarafından muaf tutuldu.

Comparison of the TriAGe+ and Sudbury scores for stroke prediction in acute vertigo in the emergency department: A retrospective analysis

Öz

Aim: Acute dizziness is a frequent emergency department (ED) presentation, in which stroke, although relatively infrequent, is clinically significant and remains a major diagnostic challenge. We aimed to comparatively evaluate the performance of the TriAGe+ and Sudbury scores for predicting stroke in patients presenting to the ED with acute vertigo or dizziness. Material and Methods: This retrospective study was conducted in a single center and included 256 adult patients presenting to the ED with dizziness or vertigo between 2020 and 2025 (128 stroke, 128 non-stroke). Our primary outcome was the diagnostic accuracy of the TriAGe+ and Sudbury scores for predicting stroke in this patient population. The diagnostic accuracies of the two scores were compared using Receiver operating characteristic (ROC) analysis and the DeLong test. Results: The TriAGe+ score showed superior diagnostic performance compared with the Sudbury score (AUC 0.898 vs. 0.837; ΔAUC = 0.061; p = 0.005). At an optimal cut-off of ≥7, TriAGe+ reached 75.0% (95% CI: 66.6–82.2) sensitivity and 83.6% (95% CI: 76.0–89.5) specificity, while Sudbury showed 78.9% (95% CI: 70.8–85.6) sensitivity and 74.2% (95% CI: 65.7–81.5) specificity. The exclusion power of the TriAGe+ score (≥5 points) was higher due to the negative likelihood ratio of 0.09 (95% CI: 0.04–0.18). The diagnostic power of this score (≥10 points) was also higher due to its 100% (95% CI: 97.2–100.0) specificity and 100% (95% CI: 92.6–100.0) positive predictive value. Conclusion: The TriAGe+ score outperformed the Sudbury score in predicting stroke among patients presenting to the ED with acute dizziness. A TriAGe+ score at the very-high-risk threshold showed good diagnostic accuracy for stroke in our cohort. These findings, while encouraging, require external validation in prospective ED populations before routine clinical use.

Anahtar Kelimeler

• Dizziness
• emergency department
• stroke
• Sudbury
• TriAGe+
• vertigo

Destekleyen Kurum

The authors declare that the study received no funding.

Etik Beyan

The study was approved by the Ethics Committee of Karadeniz Technical University Faculty of Medicine (date: 18.02.2026, number: 2026/42). The study was conducted in accordance with the principles of the Declaration of Helsinki. As this was a retrospective study based on anonymized patient records, the requirement for informed consent was waived by the ethics committee.

Teşekkür

None.

Kaynakça

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