Dizziness/vertigo triage workflow

Structured dizziness workflow prioritizing stroke/cardiac exclusion and safe outpatient follow-up boundaries.

Medium-risk workflowLast reviewed September 4, 2026

AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Scope

Use for

Initial adult dizziness/vertigo triage; acute persistent vestibular symptoms require assessment for posterior circulation stroke.

Not for

Acute focal neurologic deficits or severe gait instability requiring emergency evaluation.
Active hemodynamic instability or ongoing syncope pathway care.

Classify by timing and triggers: continuous acute dizziness, spontaneous episodes, or brief position-triggered episodes. Head movement worsening continuous symptoms does not establish BPPV.
Check vital signs, medications/volume loss, hearing, eye movements, cranial nerves, limb coordination, and gait; assess orthostatic blood pressure/pulse when safe and obtain ECG for a presyncope/arrhythmia pattern.

Treat these as urgent. Escalate early if concern persists or follow-up is unreliable.

Activate a stroke/emergency pathway for new focal findings, severe gait/truncal ataxia, or central/equivocal bedside findings. Posterior stroke can present without classic face/arm/speech changes.
Acute continuous vertigo with new hearing loss or no secure peripheral diagnosis needs urgent assessment; a routine head CT cannot reliably exclude posterior ischemic stroke.
Collapse, chest pain, hypotension, or severe dyspnea requires the relevant cardiac/emergency pathway.

HINTS is for trained clinicians assessing an acute vestibular syndrome with nystagmus; it is not a general dizziness screen or a test for brief positional episodes. If expertise is unavailable and stroke remains possible, escalate.
For brief positional vertigo, use Dix-Hallpike when appropriate; treat confirmed posterior-canal BPPV with Epley or refer to a trained provider. Atypical findings need reassessment.
Address medication/volume contributors and falls risk; arrange vestibular rehabilitation where indicated after a peripheral diagnosis is established.

Set follow-up for persistent/recurrent symptoms and give emergency precautions for new neurologic findings, inability to walk, collapse, or deterioration.
Sudden unilateral hearing loss warrants urgent ENT assessment even if stroke has been excluded.

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

Point to the red flags above that apply to this patient.
Confirm follow-up timing and where to go after hours.
Attach a relevant handout to reinforce the plan.
Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

Clinical owner: Family Medicine Editorial Team
Risk tier: Medium
Review cadence: Every 6 months
Last reviewed: September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.
Review status: Evidence current. Next review due March 4, 2027.