Kruschinski Carsten, Kersting Markus, Breull Alf, Kochen Michael M, Koschack Janka, Hummers-Pradier Eva
Institut für Allgemeinmedizin, OE5440, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover.
Z Evid Fortbild Qual Gesundhwes. 2008;102(5):313-9. doi: 10.1016/j.zefq.2008.05.001.
Dizziness can be due to multiple causes. However, the aetiology often remains unclear. At the same time, there is a lack of evidence-based treatment options. The aim of this study was to investigate the frequency of dizziness-related diagnoses, referrals and prescriptions in a general practice database.
Data from computerized patient records of 138 general practices participating in the MedViP project were used for cross-sectional analysis of the time period April 2001 until December 2002. The identification of dizzy patients was performed via ICD-10 diagnoses, free text fields and medication issued for dizziness. Frequencies were counted and odds ratios calculated to describe associations between diagnoses and medication.
For the period of investigation, 10,971 patients (from a total of 317,042 documented patients) were given at least one diagnosis of dizziness (prevalence 3.4%; mean age 59 years, 67.2% female). In 80.2% of the cases dizziness was coded as a symptom (R42) rather than a discrete disease. Prescriptions for dizziness were rather uncommon. An analysis of ATC codes showed that 6.6% of all affected patients were prescribed a specific drug for dizziness, most frequently betahistine. Antiemetics were prescribed in 7.1%, and the homeopathic preparation "Vertigoheel" in 2.8% of the dizzy patients. Betahistine was significantly more often prescribed for "unspecified" dizziness, vestibular neuritis, and benign paroxysmal positional vertigo; but not for Meniere's disease. It was given less often in "other peripheral" and in central vertigo as well as in cases where the symptom was coded (R42). 3.9% of the dizzy patients had been referred to the neurologist (55.4%), ENT-specialist (30.5%) or to both specialists (14.1%).
The manner of coding and prescribing reflects both a symptom-orientated classification used by general practitioners and the limitation of treatment options.
头晕可能由多种原因引起。然而，其病因往往仍不明确。与此同时，缺乏基于证据的治疗方案。本研究的目的是调查一个全科医疗数据库中与头晕相关的诊断、转诊和处方的频率。
来自参与MedViP项目的138家全科诊所的计算机化患者记录数据用于对2001年4月至2002年12月期间进行横断面分析。通过国际疾病分类第十版（ICD - 10）诊断、自由文本字段和开具的治疗头晕的药物来识别头晕患者。计算频率并计算比值比以描述诊断与药物之间的关联。
在调查期间，10971名患者（在总共317042名有记录的患者中）至少有一次头晕诊断（患病率3.4%；平均年龄59岁，女性占67.2%）。在80.2%的病例中，头晕被编码为一种症状（R42）而非一种独立的疾病。治疗头晕的处方相当少见。对解剖学治疗学化学分类代码（ATC）的分析表明，所有受影响患者中有6.6%被开具了治疗头晕的特定药物，最常用的是倍他司汀。7.1%的头晕患者开具了止吐药，2.8%的头晕患者开具了顺势疗法制剂“Vertigoheel”。倍他司汀在“未明确的”头晕、前庭神经炎和良性阵发性位置性眩晕中开具得明显更频繁；但在梅尼埃病中并非如此。在“其他外周性”和中枢性眩晕以及症状被编码为（R42）的病例中开具得较少。3.9%的头晕患者被转诊至神经科医生（55.4%）、耳鼻喉科专家（30.5%）或同时转诊至这两个专科医生（14.1%）。
编码和开处方的方式既反映了全科医生采用的以症状为导向的分类方法，也反映了治疗选择的局限性。
