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

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.