Faculty Collaboration Database

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses. JAMA Otolaryngol Head Neck Surg 2016 Apr;142(4):351-6

Date

02/26/2016

Pubmed ID

26913615

Pubmed Central ID

PMC5070446

DOI

10.1001/jamaoto.2015.3663

Scopus ID

2-s2.0-84964655295 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

IMPORTANCE: Treatment of patients with vestibular disorders can be complex, requires lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders, allowing for more efficient allocation of resources and use of clinicians.

OBJECTIVE: To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of 414 consecutive new vestibular patient intake questionnaires (September 2012 through January 2014) and associated medical records with performance of logistic regression analyses and development of predictive models (July 2013 through May 2015).

INTERVENTIONS: Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness.

MAIN OUTCOMES AND MEASURES: Predictors for the diagnosis of benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular migraine.

RESULTS: Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary to define a final diagnosis. Patients were 34% male and had a mean (range) age of 57 (19-91) years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%) of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Ménière's disease could be predicted from 5 variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from 4 variables with a sensitivity of 76% and specificity of 59%.

CONCLUSIONS AND RELEVANCE: A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable the use of shorter questionnaires or screening algorithms.

Author List

Friedland DR, Tarima S, Erbe C, Miles A

Authors

David R. Friedland MD Associate Director, Director, Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Sergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Models, Statistical
Predictive Value of Tests
Surveys and Questionnaires
Vestibular Diseases
Vestibular Function Tests
Young Adult