Renner Vera, Geißler Katharina, Boeger Daniel, Buentzel Jens, Esser Dirk, Hoffmann Kerstin, Jecker Peter, Mueller Andreas, Radtke Gerald, Axer Hubertus, Guntinas-Lichius Orlando
*Department of Otorhinolaryngology, Jena University Hospital, Jena †Department of Otorhinolaryngology, Zentralklinikum, Suhl ‡Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen §Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt ||Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar ¶Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen #Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera **Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt ††Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
Otol Neurotol. 2017 Dec;38(10):e460-e469. doi: 10.1097/MAO.0000000000001568.
To determine inpatient treatment rates of patients with dizziness with focus on diagnostics, treatment and outcome.
Retrospective population-based study.
Inpatients in the federal state Thuringia in 2014.
All 1,262 inpatients (62% females, median age: 61 yr) treated for inpatient dizziness were included.
The association between analyzed parameters and probability of improvement and recovery was tested using univariable and multivariable statistics.
Final diagnosis at demission was peripheral vestibular disorder (PVD), central vestibular disorder (CVD), cardiovascular syndrome, somatoform syndrome, and unclassified disease in 75, 9, 3, 0.6, and 13%, respectively. The most frequent diseases were acute vestibular neuritis (28%) and benign paroxysmal positional vertigo (22%). The follow-up time was 38 ± 98 days. 88.5% of patients showed at least an improvement of complaints and 31.4% a complete recovery. The probability for no improvement from inpatient dizziness was higher if the patient had a history of ear/vestibular disease (hazard ratio [HR] = 1.506; 95% confidence interval [CI] = 1.301-1.742), and was taking more than two drugs for comorbidity (HR = 1.163; CI = 1.032-1.310). Compared with final diagnosis of cardiovascular syndrome, patients with PVD (HR = 1.715; CI = 1.219-2.415) and CVD (HR = 1.587; CI = 1.076-2.341) had a worse outcome.
Inpatient treatment of dizziness was highly variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. We need better ways to implement clinical trial findings for inpatients with dizziness.
确定头晕患者的住院治疗率,重点关注诊断、治疗及结果。
基于人群的回顾性研究。
2014年图林根州的住院患者。
纳入所有1262例因头晕住院治疗的患者(女性占62%,中位年龄:61岁)。
使用单变量和多变量统计方法检验分析参数与改善及康复概率之间的关联。
出院时的最终诊断分别为外周前庭疾病(PVD)、中枢前庭疾病(CVD)、心血管综合征、躯体形式综合征和未分类疾病,占比分别为75%、9%、3%、0.6%和13%。最常见的疾病是急性前庭神经炎(28%)和良性阵发性位置性眩晕(22%)。随访时间为38±98天。88.5%的患者至少有症状改善,31.4%的患者完全康复。如果患者有耳/前庭疾病史,头晕住院后无改善的概率更高(风险比[HR]=1.506;95%置信区间[CI]=1.301 - 1.742),且因合并症服用两种以上药物时也是如此(HR=1.163;CI=1.032 - 1.310)。与心血管综合征的最终诊断相比,PVD患者(HR=1.715;CI=1.219 - 2.415)和CVD患者(HR=1.587;CI=1.076 - 2.341)的预后更差。
在日常实践中,头晕的住院治疗差异很大。基于人群的康复率比临床试验报告的更差。我们需要更好的方法将临床试验结果应用于头晕住院患者。