Therapeutic approaches and their association with hospitalization duration in patients with peripheral vertigo presenting to the emergency department

Abstract Background Acute peripheral vertigo often demands rapid treatment and specialty input in the emergency department (ED). We examined how real‑world treatment patterns relate to ED length of stay (LOS). Methods We performed a cross‑sectional review of adults with peripheral vertigo at Rasool‑e‑Akram Hospital (Tehran, Jan–Jun 2024). After prespecified exclusions, 96 encounters remained. Vertigo‑specific drugs (ondansetron, betahistine, promethazine, metoclopramide, benzodiazepines), regimen complexity (≤ 2 vs. ≥ 3 drugs), and consultations were abstracted; LOS (minutes) was the outcome. Linear regression adjusted for age, sex, regimen complexity, consultations, and self‑discharge; secondary models estimated drug‑specific associations. Results Median LOS was longer with complex regimens than with simpler regimens (652 vs. 467.5 min; p = 0.0016). In the adjusted model, regimen complexity ≥ 3 drugs was associated with a 180.9‑minute longer LOS (95% confidence interval (CI) 76.0–285.7; p = 0.0009). Neurology (β 163.9 min), internal medicine (β 501.3 min) and ENT (β 476.0 min) consultations were likewise associated with longer stays (all p < 0.01). Drug‑specific models showed benzodiazepines linked to longer LOS (β 356.2 min; p < 0.0001) and promethazine linked to shorter LOS (β − 161.3 min; p = 0.015); other agents showed no clear independent association. Conclusion In this ED cohort, simpler pharmacotherapy and selective consultation were associated with shorter LOS, whereas complex regimens and certain consultations tracked with longer stays. These findings are hypothesis‑generating and support evaluating stepwise treatment pathways in prospective studies.