This study aims to examine potential sex-based disparities in the rates of gait assessment in vertiginous patients.

Gait assessment (GA) is a vital component of the emergency department (ED) neurological examination, particularly for detecting life-threatening conditions such as posterior circulation stroke (PCS). Notably, a higher proportion of patients presenting to the ED with acute vertigo are female. Despite this increased incidence, it remains unclear whether sex influences the likelihood of receiving GA in this clinical context.

In this retrospective case-control study, we analyzed medical records of 434 acutely vertiginous patients from the Get-With-The-Guidelines-Database at an academic hospital in New York City. Among these, 52 were diagnosed with PCS, and 382 had no evidence of PCS based on imaging and clinical criteria. Statistical analysis was performed using a two-tailed, t-test assuming equal variances to assess the relationship between sex, age, and the likelihood of GA.

Average age was 67.3 years in patients with GA (n=347), and 69.7 years in those without GA (n=86) (p=0.1944). Females comprised 62.8% of patients without GA, compared to 49.0% with GA (p=0.0219). Among patients with PCS, 75% of those without GA were female (n=12), compared to 47.5% with GA (n=40) (p=0.1140). In the non-PCS group, 60.1% of those without GA were female (n=308), compared to 49.0% with GA (n=74) (p=0.0934).

Our study identified a significant disparity in the rate of gait assessment among acutely vertiginous patients in the ED, with females being significantly less likely to receive this examination. Although neither subgroup achieved statistical significance, this disparity persisted across both PCS and non-PCS subgroups, with the trend more pronounced in the non-PCS group. These findings suggest a potential sex-based bias in decision-making, warranting further investigation through dedicated prospective studies to ensure that all patients receive appropriate and timely neurological assessments.