Zwergal Andreas, Mantokoudis Georgios, Heg Dierik, Kerkeni Hassen, Diener Suzie, Kalla Roger, Korda Athanasia, Candreia Claudia, Welge-Lüssen Antje, Tarnutzer Alexander A
German Center for Vertigo and Balance Disorders (DSGZ), Ludwig Maximilian University Hospital, Munich, Germany.
Department of Neurology, Ludwig Maximilian University Hospital, Munich, Germany.
Front Neurol. 2023 Sep 7;14:1254080. doi: 10.3389/fneur.2023.1254080. eCollection 2023.
Vertigo and dizziness are among the most frequent presenting symptoms in the primary care physicians' (PCPs) office. With patients facing difficulties in describing their complaints and clinical findings often being subtle and transient, the diagnostic workup of the dizzy patient remains challenging. We aimed to gain more insights into the current state of practice in order to identify the limitations and needs of the PCPs and define strategies to continuously improve their knowledge in the care of the dizzy patient.
Board-certified PCPs working in Switzerland were invited to participate in an online survey. A descriptive statistical analysis was performed, and prospectively defined hypotheses were assessed using regression analyses.
A vast majority of participating PCPs ( = 152) were familiar with the key questions when taking the dizzy patient's history and with performing provocation/repositioning maneuvers when posterior-canal benign paroxysmal positional vertigo (BPPV) was suspected (91%). In contrast, strong agreement that performing the alternating cover test (21%), looking for a spontaneous nystagmus with fixation removed (42%), and performing the head-impulse test (47%) were important was considerably lower, and only 19% of PCPs were familiar with lateral-canal BPPV treatment. No specific diagnosis could be reached in substantial fractions of patients with acute (35% [25; 50%], median [inter-quartile range]) and episodic/chronic (50% [40; 65.8%]) dizziness/vertigo. Referral to specialists was higher in patients with episodic/chronic dizziness than in acutely dizzy patients (50% [20.3; 75] vs. 30% [20; 50]), with younger PCPs (aged 30-40 years) demonstrating significantly increased odds of referral to specialists (odds ratio = 2.20 [1.01-4.81], = 0.048).
The assessment of dizzy patients takes longer than that of average patients in most primary care practices. Many dizzy patients remain undiagnosed even after a thorough examination, highlighting the challenges faced by PCPs and potentially leading to frequent referrals to specialists. To address this, it is crucial to promote state-of-the-art neuro-otological examination and treatment techniques that are currently neglected by most PCPs, such as "HINTS" and lateral-canal BPPV treatment. This can help reduce referral rates allowing more targeted treatment and referrals.
眩晕和头晕是基层医疗医生（PCP）办公室中最常见的就诊症状。由于患者在描述其症状时面临困难，且临床发现往往细微且短暂，对头晕患者的诊断检查仍然具有挑战性。我们旨在更深入地了解当前的实践状况，以确定基层医疗医生的局限性和需求，并确定持续提高他们在头晕患者护理方面知识的策略。
邀请在瑞士工作的获得委员会认证的基层医疗医生参与在线调查。进行了描述性统计分析，并使用回归分析评估了预先定义的假设。
绝大多数参与调查的基层医疗医生（n = 152）在询问头晕患者病史时熟悉关键问题，并且在怀疑后半规管良性阵发性位置性眩晕（BPPV）时熟悉进行激发/复位操作（91%）。相比之下，对于进行交替遮盖试验（21%）、去除注视寻找自发性眼球震颤（42%）以及进行摇头试验（47%）很重要这一点，强烈认同的比例要低得多，并且只有19%的基层医疗医生熟悉外半规管BPPV的治疗。相当一部分急性（35% [25; 50%]，中位数[四分位间距]）和发作性/慢性（50% [40; 65.8%]）头晕/眩晕患者无法得出明确诊断。发作性/慢性头晕患者转诊至专科医生的比例高于急性头晕患者（50% [20.3; 75] 对 30% [20; 50]），年轻的基层医疗医生（30 - 40岁）转诊至专科医生的几率显著增加（优势比 = 2.20 [1.01 - 4.81]，P = 0.048）。
在大多数基层医疗实践中，对头晕患者的评估比普通患者花费的时间更长。即使经过全面检查，许多头晕患者仍未得到诊断，这凸显了基层医疗医生面临的挑战，并可能导致频繁转诊至专科医生。为解决这一问题，推广目前大多数基层医疗医生忽视的先进神经耳科检查和治疗技术至关重要，例如“HINTS”和外半规管BPPV治疗。这有助于降低转诊率，实现更有针对性的治疗和转诊。
