Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Iniversiteit Amsterdam, Amsterdam, The Netherlands.
Ann Fam Med. 2018 Sep;16(5):428-435. doi: 10.1370/afm.2289.
Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool.
We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] ≥30), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI ≥30) after 6 months.
Prevalence of an unfavorable course of dizziness was 73.9% in the development cohort and 43.6% in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice.
We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.
由于老年人头晕常常是慢性的，并且会严重影响日常功能，因此识别那些头晕不良预后风险较高的患者对于优化他们的治疗非常重要。我们旨在开发和外部验证一种用于初级保健中老年患者头晕不良预后的预测模型，并构建一种易于使用的风险预测工具。
我们使用了来自 2 个前瞻性队列的数据：一个包括 203 名年龄在 65 岁或以上的患者的队列，这些患者因头晕就诊于他们的初级保健医生，并且存在明显的与头晕相关的损害（头晕残疾问卷[DHI]≥30）；另一个包括 415 名年龄在 65 岁或以上的患者的队列，这些患者因任何严重程度的头晕就诊于他们的初级保健医生。不良预后定义为 6 个月后存在明显的与头晕相关的损害（DHI≥30）。
在开发队列中，头晕不良预后的发生率为 73.9%，在验证队列中为 43.6%。最终模型中的预测因素包括 DHI 筛查版本的得分、年龄、心律失常史和抬头作为诱发因素。该模型显示出良好的校准和适度的区分能力（曲线下面积=0.77）。在外部验证中，区分能力仍然稳定（曲线下面积=0.78）。构建的风险评分与预测模型密切相关。为了确定最佳的临床实践切点，还呈现了风险评分切点值的性能测量结果。
我们开发了一种用于初级保健中与头晕相关的损害的易于使用的风险评分。该风险评分仅包含 4 个预测因素，将帮助初级保健医生识别头晕不良预后风险较高的患者。
