Department of Otorhinolaryngology-Head and Neck Surgery, University Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.
JAMA Otolaryngol Head Neck Surg. 2019 Jun 1;145(6):550-560. doi: 10.1001/jamaoto.2019.0243.
Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed.
To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms.
In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018.
We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0% and 100% (median, 41%), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56% and 100% (median, 94%).
Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.
前庭症状是全球医学中最常见的主诉之一。这些症状表现出的潜在疾病通常与前庭眼反射功能障碍有关，可以通过不同的诊断程序进行评估。近年来，越来越多的比较各种头部脉冲测试（HIT）方法与其他诊断程序的诊断测试准确性研究发表，但尚未进行系统评价。
进行范围界定综述，并描述呈现前庭症状患者不断增加的诊断研究的关键特征。
2017 年 4 月，通过对 4 个文献数据库（Medline、科学引文索引扩展版、Cochrane 图书馆和 ScienceDirect）进行检索，确定了已发表的研究。如果研究提供了任何 HIT 方法的诊断准确性数据（敏感性和特异性），并将其与前庭症状患者的任何其他前庭测试或临床诊断进行了比较，则将这些研究纳入。提取了研究的关键特征，并对当前文献进行了叙述性描述。所有分析均于 2017 年 6 月至 2018 年 7 月进行。
我们共确定了 27 项诊断研究（包括 3821 名参与者）。当比较不同的 HIT 方法与其他诊断程序时，研究内和研究间的诊断测试准确性数据存在分歧。患有疾病的人的正确识别比例（敏感性）在 0%至 100%之间（中位数为 41%），而没有疾病的人的正确识别比例（特异性）更高，在 56%至 100%之间（中位数为 94%）。
基于本综述中纳入的研究，不能通过 HIT 方法可靠地估计前庭症状患者的敏感性、特异性，更重要的是，误诊的风险以及相关的治疗不足或过度治疗。我们建议进一步的诊断研究考虑（1）前庭症状的多种可能潜在原因和多种测试阈值，（2）有和没有疾病的患者的代表性样本，以及（3）诊断测试准确性研究的报告指南。
