Melliti Ali A, Bhandari Rajneesh, Bhandari Anita, Castellucci Andrea, Gerards Marie-Cecile, Myers Bre, Ola Vipin, Oostenbrink Peter, Van Kampen Hans, Vanbelle Sophie, van de Berg Raymond
Division of Vestibular Disorders, Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, 6229 HX, The Netherlands.
NeuroEquilibrium Diagnostic Systems Pvt Ltd., Jaipur, India.
Sci Rep. 2025 Aug 17;15(1):30149. doi: 10.1038/s41598-025-15807-x.
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most prevalent peripheral vestibular disorders seen in specialized dizziness clinics. Despite being a well-understood condition with effective treatment options, BPPV remains associated with significant diagnostic delays and healthcare costs. If proven reliable, telemedicine approaches could help address these challenges by improving diagnostic accessibility and efficiency. To investigate the interobserver agreement in BPPV diagnosis, when using eye movement recordings. Six vestibular medicine specialists (Specialist 1, 2, 3, 4, 5, 6) were recruited to participate in this study. The specialists were asked to evaluate the recordings of 240 patient cases who underwent assessment for BPPV (first assessment). After viewing the recordings of each case, they were required to make a BPPV diagnosis. Five specialists (2, 3, 4, 5, 6) agreed to repeat the procedure twice, to additionally evaluate the intraobserver agreement (second assessment). The proportion of agreement and Cohen's kappa were calculated for both interobserver and intraobserver agreement. Furthermore, agreement with the original diagnoses was evaluated. The interobserver agreement between experts was fair to moderate with a Cohen's kappa value of 0.40 (CI 95% [0.35, 0.45]) and a proportion of agreement of 60% (CI 95% [54, 67]). Specialists 2, 4, and 5 exhibited substantial intraobserver agreement. In contrast, Specialist 3 demonstrated fair intraobserver agreement, while Specialist 6 showed almost perfect intraobserver agreement. Regarding the first assessment, agreement with the original diagnoses ranged from fair to substantial, with kappa values between 0.40 and 0.70, and corresponding percentages between 58 and 78%. Similar results were observed for the second assessment. The interobserver agreement between specialists diagnosing BPPV using eye movement recordings, was fair to moderate. The suboptimal agreement could be related to missing clinical information (e.g. patient history and symptoms during positional maneuvers). Future studies should incorporate this information and reassess interobserver agreement.
良性阵发性位置性眩晕（BPPV）是专科头晕诊所中最常见的外周前庭疾病之一。尽管这是一种已被充分了解且有有效治疗方案的病症，但BPPV仍与显著的诊断延迟和医疗成本相关。如果经证实可靠，远程医疗方法可以通过提高诊断的可及性和效率来帮助应对这些挑战。为了研究在使用眼动记录时BPPV诊断中的观察者间一致性。招募了六位前庭医学专家（专家1、2、3、4、5、6）参与本研究。要求专家们评估240例接受BPPV评估（首次评估）的患者病例的记录。在查看每个病例的记录后，他们需要做出BPPV诊断。五位专家（2、3、4、5、6）同意重复该过程两次，以额外评估观察者内一致性（第二次评估）。计算了观察者间和观察者内一致性的一致比例和科恩kappa系数。此外，评估了与原始诊断的一致性。专家之间的观察者间一致性为中等，科恩kappa值为0.40（95%置信区间[0.35, 0.45]），一致比例为60%（95%置信区间[54, 67]）。专家2、4和5表现出高度的观察者内一致性。相比之下，专家3表现出中等的观察者内一致性，而专家6表现出几乎完美的观察者内一致性。关于首次评估，与原始诊断的一致性从中等到高度不等，kappa值在0.40至0.70之间，相应百分比在58%至78%之间。第二次评估观察到类似结果。使用眼动记录诊断BPPV的专家之间的观察者间一致性为中等至公平。一致性欠佳可能与缺少临床信息（如患者病史和位置性手法操作期间的症状）有关。未来的研究应纳入这些信息并重新评估观察者间一致性。
