Acute vertigo is common, accounting for approximately 4% of global ED visits. Differentiating between benign peripheral vestibular dysfunction and serious central pathologies such as stroke poses a significant clinical challenge. Existing diagnostic tools like HINTS-plus and STANDING algorithms have high sensitivity and specificity but are often underutilised due to limited clinician training and over-reliance on brain imaging.

A prospective cohort study was conducted on 70 adult patients referred to an acute vertigo clinic at the National Hospital for Neurology and Neurosurgery, UK. Data on patient demographics, clinical presentations, diagnostic assessments, and outcomes were collected from both ED and specialist evaluations. Statistical analyses, including logistic regression and ROC curve analysis, were performed to assess the diagnostic predictors.

Our study demonstrates significant diagnostic discrepancies between ED clinicians and acute vertigo specialists, emphasising the need for improved training and the implementation of advanced diagnostic protocols in the ED. Detailed clinical assessments, such as the HINTS-plus exam and ABCD2 score, are critical for accurate diagnosis, particularly in younger patients. Addressing these gaps is crucial for optimising care and reducing the economic burden of AV misdiagnoses in emergency settings.