To construct an optimal diagnostic protocol enabling general practitioners to distinguish between dizzy elderly patients who need treatment, dizzy elderly patients who need further diagnostics and dizzy elderly patients who need no further…
ID
Source
Brief title
Condition
- Cardiac arrhythmias
- Middle ear disorders (excl congenital)
- Peripheral neuropathies
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The combination of tests that is most discriminative in dizzy elderly patients
with the judgement of an expert panel on the most desired medical management as
reference. We aim to formulate diagnostic (prognostic) rules for the management
of dizziness in elderly in general practice.
De combinatie van testen die het meest onderscheidend is bij duizeligheid van
de oudere patiënt ten opzichte van de referentiestandaard: het oordeel van een
deskundigenpanel ten aanzien van het te voeren beleid. Het streven is om
diagnostische (en prognostische) regels te formuleren ten aanzien van het
beleid bij duizeligheid bij ouderen in de huisartspraktijk.
Secondary outcome
In the study for determinants the endpoints are clinical profiles, i.e.
combinations of conditions (physical and/or mental), known by certain test
results, that correlate with the complaint of dizziness. With a panel diagnosis
as reference standard we will be able to determine the diagnostic odds ratio
and likelihood ratios of diagnostic tests or combination of tests for some
frequently occurring diagnoses.
- diagnostic profiles, i.e. combinations of conditions (physical and/or
mental), that correlate with the existance of complaints of dizziness.
-diagnostic odds ratios and likelihoodratios of (combinations of) test results
for some highly prevalent diagnsoses.
Background summary
Much is unknown about the cause and prognosis of dizziness (especially in the
elderly) and the benefit of further diagnostics. An integrated and multivariate
approach to quantify which conditions contribute to the complaints of dizziness
and which diagnostic tests contribute to the diagnostic process and management
of dizziness in the elderly is needed
Study objective
To construct an optimal diagnostic protocol enabling general practitioners to
distinguish between dizzy elderly patients who need treatment, dizzy elderly
patients who need further diagnostics and dizzy elderly patients who need no
further diagnostics and for whom a wait & see policy is recommended. Other
objectives of this study are to obtain a better understanding of determinants
contributing to dizziness in the elderly and to assess the test characteristics
of the tests used to diagnose dizziness in the elderly.
Study design
In patients presenting with complaints of dizziness and in a matched group of
non-dizzy patients a standardised diagnostic testprotocol will be applied. This
protocol consists of 22 tests, which were considered by an international
expertpanel as possibly contributory to diagnosing dizziness in the elderly and
feasible in primary care.
The study exists of three parts: an evaluation of the diagnostic protocol with
emphasis on prognosis in a cross-sectional design; the determination of
determinants to dizziness in the elderly in a case control design; an
evaluation of test characteristics of used tests with emphasis on diagnosis in
a cross-sectional design. The results of diagnostic tests are the independent
variables. Three different dependant variables are used: 1. the judgement of a
panel of experts on medical management 2. the presence oo dizziness 3. the
diagnosis, as given by the expert panel.
Study burden and risks
The risks for patients and controls participating in this project will be
negligible. We apply no medical therapeutic interventions, other than usual
care. There will be some burden for patients and controls, due to their age,
probable impairments and complaints. Performance of the protocol takes about 45
minutes and a capillary puncture is required to measure hemoglobin and glucose.
If possible we perform tests in sitting or lying position. There are no direct
benefits for controls. The benefit for patients is the identification of
contributing factors to their dizziness. With this knowledge their GP*s can at
least inform them, and sometimes guide them in treatment and appropriate
specialist referral, if required.
Meibergdreef 15
1105 AZ
Nederland
Meibergdreef 15
1105 AZ
Nederland
Listed location countries
Age
Inclusion criteria
consultation in general practice for dizziness
Exclusion criteria
- no complaints of dizziness at inclusion (which will be about 3-4 weeks after peresentation to the general practitioner)
- not able to communicate in Dutch or English
- cognitive impairment
- blindness (visual acuity < 3/60 in the better seeing eye. This means that the better seeing eye cannot identify the orientation of the break in the top ring at three metres on the Landolt*s broken-ring chart)
- deafness (permanent and profound loss of hearing in both ears with more than 90 decibels loss on the three frequencies of the Fletcher -index)
- totally wheelchair bound
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL11947.018.06 |