Leemeyer Anna-Marie R, Ross Andrew K, Bruintjes Tjasse D, Cals Jochen W L, van Leeuwen Roeland B, Lissenberg-Witte Birgit I, van Vugt Vincent A, Maarsingh Otto R
Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan, Amsterdam, 1117, the Netherlands.
Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
BMC Prim Care. 2025 Aug 2;26(1):238. doi: 10.1186/s12875-025-02920-z.
Vertigo is a common symptom that strongly impacts patients' quality of life. More than 80% of patients experiencing vertigo are primarily treated by their general practitioner (GP). The GP's'diagnostic toolkit' for vertigo has serious limitations, though, because diagnostic accuracy studies on conditions that may cause vertigo have never been performed in a general practice setting. Our aim was to determine which tests should be investigated in a diagnostic accuracy study for patients with vertigo in general practice.
We conducted an online Delphi procedure involving national and international experts. The experts were asked to judge a selection of 40 diagnostic tests based on the Dutch GP guideline on vestibular symptoms, supplemented by tests identified during a systematic review. Panellists were allowed to suggest additional tests after the first round. In case of consensus of at least 70%, a test was included or excluded. We also conducted a secondary sub-analysis of our Delphi procedure to demonstrate non-dominance of Dutch experts within our expert panel. Data were analysed using descriptive statistics and content analysis. Data were analysed using descriptive statistics and content analysis.
A panel of 20 experts from five countries, including 7 specialists in otolaryngology, 6 neurologists and 7 GPs, participated in the Delphi procedure. The panel judged 46 diagnostic tests in total, with 6 additional tests added to the original selection based on suggestions by experts. After the first two rounds (100% response rate), 16 tests were included, 22 tests were excluded and no consensus was reached on 8 tests. During the consensus round, one of the 8 tests was added to the included 16 tests. Of these 17 tests, 15 are recommended by the Dutch GP guideline, supplemented by the non-recommended Tandem walking test and the Romberg test.
An international expert panel reached consensus on 17 tests for vertigo in general practice that should be investigated in a diagnostic accuracy study.
眩晕是一种常见症状，对患者的生活质量有很大影响。超过80%的眩晕患者主要由其全科医生（GP）进行治疗。然而，全科医生用于眩晕的“诊断工具包”存在严重局限性，因为在全科医疗环境中从未进行过关于可能导致眩晕病症的诊断准确性研究。我们的目的是确定在全科医疗中针对眩晕患者的诊断准确性研究中应调查哪些测试。
我们进行了一项涉及国内和国际专家的在线德尔菲法程序。专家们被要求根据荷兰全科医生关于前庭症状的指南，对40项诊断测试进行评估，并辅以系统评价中确定的测试。在第一轮之后，小组成员可以建议其他测试。如果至少70%达成共识，则纳入或排除一项测试。我们还对德尔菲法程序进行了二次子分析，以证明荷兰专家在我们的专家小组中不占主导地位。使用描述性统计和内容分析对数据进行分析。
来自五个国家的20名专家组成的小组参与了德尔菲法程序，其中包括7名耳鼻喉科专家（otolaryngology）、6名神经科医生和7名全科医生。该小组总共评估了46项诊断测试，根据专家建议在最初的选择中增加了6项测试。在前两轮（100%的回复率）之后，16项测试被纳入，22项测试被排除，8项测试未达成共识。在共识轮中，8项测试中的一项被添加到纳入的16项测试中。在这17项测试中，15项是荷兰全科医生指南推荐的，另外补充了未被推荐的串联行走测试和罗姆伯格测试（Romberg test）。
一个国际专家小组就全科医疗中用于眩晕的17项测试达成了共识，这些测试应在诊断准确性研究中进行调查。
