TY - JOUR
T1 - Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice
T2 - study protocol
AU - Ross, Andrew
AU - Leemeyer, Anna-Marie Rebecca
AU - Bruintjes, Tjasse D
AU - Cals, Jochen W L
AU - Bronstein, Adolfo
AU - van Leeuwen, Roeland B
AU - Lissenberg-Witte, Birgit
AU - van Vugt, Vincent Alexander
AU - Rutgers, Sandra
AU - Maarsingh, Otto R
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2024.
PY - 2024/4/2
Y1 - 2024/4/2
N2 - Introduction Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP’s diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders (‘How well does test x discriminate between patients with or without target condition y?’) has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap. Methods and analysis We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) Ménière’s disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition. Ethics and dissemination The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817—NL83111.029.22). We will publish our findings in peer-reviewed international journals.
AB - Introduction Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP’s diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders (‘How well does test x discriminate between patients with or without target condition y?’) has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap. Methods and analysis We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) Ménière’s disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition. Ethics and dissemination The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817—NL83111.029.22). We will publish our findings in peer-reviewed international journals.
KW - Adult
KW - Benign Paroxysmal Positional Vertigo
KW - General Practice
KW - Humans
KW - Medical History Taking
KW - Migraine Disorders/diagnosis
KW - Physical Examination
KW - Prospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85189663323&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2024-085715
DO - 10.1136/bmjopen-2024-085715
M3 - Article
C2 - 38569697
SN - 2044-6055
VL - 14
SP - e085715
JO - BMJ Open
JF - BMJ Open
IS - 4
M1 - e085715
ER -