Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Division of Neurology, Department of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Otolaryngol Head Neck Surg. 2019 Mar 11;48(1):11. doi: 10.1186/s40463-019-0336-9.
Vertigo remains a diagnostic challenge for primary care, emergency, and specialist physicians. Multidisciplinary clinics are increasingly being employed to diagnose and manage patients with dizziness. We describe, for the first time in Canada, the clinical characteristics of patients presenting with chronic and acute dizziness to both a multidisciplinary chronic dizziness clinic (MDC) and a rapid access dizziness (RAD) clinic at The Ottawa Hospital (TOH).
We performed a retrospective review of all patients presenting to the MDC and RAD clinics at TOH from July 2015 to August 2017.
Overall, 211 patients (median age: 61 years old) presented to the RAD clinic and 292 patients (median age: 55 years old) presented to the MDC. In the RAD clinic, 63% of patients had peripheral dizziness, of which 55% had BPPV, and only one patient had functional dizziness. Interestingly, only 25% of RAD diagnoses were concordant with emergency department diagnoses; moreover, only 33% of RAD patients had HiNTS completed, while 44% had CT scans, of which only one scan had an abnormal finding. Prior to assessment, all patients in the MDC had an unclear cause of dizziness. 28% of patients had vestibular dizziness and 21% had functional dizziness, of which 43% had persistent postural perceptual dizziness. Moreover, 12% of patients with functional dizziness also suffered from comorbid severe anxiety and depression.
Dizziness is a heterogeneous disorder that necessitates multidisciplinary care, and clinics targeting both the acute and chronic setting can improve diagnostic accuracy, ensure appropriate diagnostic testing, and facilitate effective care plans for patients with dizziness.
眩晕仍然是初级保健、急诊和专科医生面临的诊断挑战。越来越多的多学科诊所被用于诊断和管理头晕患者。我们首次在加拿大描述了同时到多学科慢性头晕诊所（MDC）和渥太华医院（TOH）快速就诊头晕（RAD）诊所就诊的慢性和急性头晕患者的临床特征。
我们对 2015 年 7 月至 2017 年 8 月期间到 TOH 的 MDC 和 RAD 诊所就诊的所有患者进行了回顾性研究。
总体而言，211 名患者（中位年龄：61 岁）就诊于 RAD 诊所，292 名患者（中位年龄：55 岁）就诊于 MDC。在 RAD 诊所，63%的患者为周围性头晕，其中 55%为良性阵发性位置性眩晕，仅有 1 例为功能性头晕。有趣的是，RAD 诊所的诊断仅 25%与急诊诊断相符；此外，仅有 25%的 RAD 患者完成了 HiNTS，而 44%的患者进行了 CT 扫描，其中仅 1 例扫描结果异常。在评估前，MDC 的所有患者均有不明原因的头晕。28%的患者为前庭性头晕，21%为功能性头晕，其中 43%为持续性姿势感知性头晕。此外，43%的功能性头晕患者还患有共病严重焦虑和抑郁。
头晕是一种异质性疾病，需要多学科治疗，针对急性和慢性两种情况的诊所可以提高诊断准确性，确保进行适当的诊断性检查，并为头晕患者制定有效的治疗计划。
