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Bayer et al. BMC Neurology 2010, 10:98 http://www.biomedcentral.com/1471-2377/10/98

RESEARCH ARTICLE

Open Access

Diagnostic indices for vertiginous diseases
Otmar Bayer1*†, Jan-Christian Warninghoff2†, Andreas Straube3
Abstract
Background: Vertigo and dizziness are symptoms which are reported frequently in clinical practice. We aimed to develop diagnostic indices for four prevalentvertiginous diseases: benign paroxysmal positional vertigo (BPPV), Menière’s disease (MD), vestibular migraine (VM), and phobic postural vertigo (PPV). Methods: Based on a detailed questionnaire handed out to consecutive patients presenting for the first time in our dizziness clinic we preselected a set of seven questions with desirable diagnostic properties when compared with the final diagnosisafter medical workup. Using exact logistic regression analysis diagnostic scores, each comprising of four to six items that can simply be added up, were built for each of the four diagnoses. Results: Of 193 patients 131 questionnaires were left after excluding those with missing consent or data. Applying the suggested cut-off points, sensitivity and specificity were 87.5 and 93.5% for BPPV, 100 and87.4% for MD, 92.3 and 83.7% for VM, 73.7 and 84.1% for PPV, respectively. By changing the cut-off points sensitivity and specificity can be adjusted to meet diagnostic needs. Conclusions: The diagnostic indices showed promising diagnostic properties. Once further validated, they could provide an ease to use and yet flexible tool for screening vertigo in clinical practice and epidemiologicalresearch.

Background Vertigo and dizziness are, like headache very prevalent symptoms in daily clinical practice. The life time prevalence is estimated to be 20 - 30% [1]. For the symptom headache it was shown that a very simple screener with only three questions are able to differentiate headaches with a sensitivity of 0.81 (95% CI 0.77 to 0.85), a specificity of 0.75 (95% CI 0.64 to 0.84), and apositive predictive value of 0.93 (95% CI, 89.9 to 95.8) to predict a migraine [2]. Therefore we investigated whether such a screener which can be easily filled out by the patients during the time in the waiting room can be also developed for patients suffering from vertigo or dizziness. We focused our efforts on the differentiation of the most prevalent diagnoses benign paroxysmal positionalvertigo (BPPV), Meniere’s disease (MD), vestibular migraine (VM) and phobic postural vertigo (PPV) since these four diagnoses cover about 54% of all patients in a dizziness out patient unit [1]. The screener was developed by
* Correspondence: Otmar.Bayer@lrz.uni-muenchen.de † Contributed equally 1 Integrated center for research and treatment of vertigo, balance and ocular motor disordersLudwig-Maximilians-University of Munich, Heiglhofstr. 63, 81377 Munich, Germany Full list of author information is available at the end of the article

analysing a larger questionnaire, which was administered to patients presenting in a dizziness clinic at the neurology department of Munich university, a tertiary center for vertigo disorders.

Methods We conceived a short questionnaire by analysing andsubsequently condensing a detailed questionnaire designed for patients suffering from vertiginous diseases. The detailed questionnaire with specific questions about vertiginous diseases evolved on the basis of the pain questionnaire of the German Society for the Study of Pain http://www.dgss.org, chapter of the IASP. Data collection was done between 2003 and 2007. In order to get detailed andstructured information about the history of the patients and the signs of the actual clinical symptoms we asked the patients to fill in the questionnaire. Since this data collection was introduced as a pilot the questionnaire was handed out on predefined dates (usually once a week) to all patients presenting for the first time in the dizziness clinic on that day to obtain an unbiased sample. All...