Friedland David R, Tarima Sergey, Erbe Christy, Miles Alexia
Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee.
Institute for Health and Society, Division of Biostatistics, Medical College of Wisconsin, Milwaukee.
JAMA Otolaryngol Head Neck Surg. 2016 Apr;142(4):351-6. doi: 10.1001/jamaoto.2015.3663.
Treatment of patients with vestibular disorders can be complex, requires lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders, allowing for more efficient allocation of resources and use of clinicians.
To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of 414 consecutive new vestibular patient intake questionnaires (September 2012 through January 2014) and associated medical records with performance of logistic regression analyses and development of predictive models (July 2013 through May 2015).
Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness.
Predictors for the diagnosis of benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular migraine.
Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary to define a final diagnosis. Patients were 34% male and had a mean (range) age of 57 (19-91) years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%) of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Ménière's disease could be predicted from 5 variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from 4 variables with a sensitivity of 76% and specificity of 59%.
A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable the use of shorter questionnaires or screening algorithms.
前庭疾病患者的治疗可能很复杂，需要较长的门诊就诊时间，并且在诊断过程中会消耗更多临床资源。就诊前的 intake 问卷可以预测最常见的疾病，从而更有效地分配资源并合理使用临床医生。
从 intake 问卷中开发一种在临床评估前预测前庭诊断的统计模型。
设计、设置和参与者：对414份连续的新前庭患者 intake 问卷（2012年9月至2014年1月）及相关病历进行回顾性分析，并进行逻辑回归分析和预测模型开发（2013年7月至2015年5月）。
使用前庭 intake 问卷对有头晕主诉的新患者进行分诊。
预测良性阵发性位置性眩晕（BPPV）、梅尼埃病和前庭性偏头痛诊断的因素。
在分析的414份问卷中，381份（92%）具有确定最终诊断所需的临床医生信息。患者中男性占34%，平均（范围）年龄为57（19 - 91）岁。在诊断中，183例（48%）与耳部相关（包括103例BPPV和49例梅尼埃病），141例（37%）为神经系统疾病（包括109例前庭性偏头痛），36例（9%）为内科疾病，8例（2%）为心理源性，46例（12%）病因不明，33例（9%）为其他原因。BPPV的诊断可由4个变量预测，敏感性为79%，特异性为65%。梅尼埃病的诊断可由5个变量预测，敏感性为81%，特异性为85%。前庭性偏头痛的诊断可由4个变量预测，敏感性为76%，特异性为59%。
就诊前病史问卷可为常见前庭疾病提供有用的诊断信息。这有助于指导预约安排，提高临床效率、缩短干预时间并合理使用资源。进一步完善可能会使使用更简短的问卷或筛查算法成为可能。
