Background
Methods
Types of studies
Inclusion- and exclusion criteria
Search strategy
Selection of publications
Data extraction
Quality assessment
Data analysis
Results
Search result and study selection
Included studies
Studies | Time of recruitment | Country | Setting | Number of dizzy patients | Mean Age of study sample (range) | Female (%) | Data collection | Inclusion criteria | Exclusion criteria | Answered research questionsb |
---|---|---|---|---|---|---|---|---|---|---|
BEACH 2014 [18] | 04/2013 - 03/2014 | Australia | 959 general practitioners | 993 | n.r. | n.r. | prospective | all patients contacts ICPC: Reason for encounter vertigo/ dizziness | 1 | |
Bird 1998 [39] | 08/1993 - 071995 | Great Britain | 3 general practices | 503 | median 58 (3-99) | n.r. | retrospective | complaining of symptoms allied to dizziness ➔ stratified sample was studied in more detail | patients had seen their GP about the same problem within the past 12 months | 1,2 |
CONTENT 2007 [1] | 04/2005 - 12/2006 | Germany | 17 general practices | 607 | n.r. | 70.8a | prospective | all patients contacts ICPC: Reason for encounter N17 – vertigo/ dizziness | 1 | |
DNSGP-2 2010 [15] | 01/2001 - 12/2001 | Netherlands | 96 family practices | 3990 | 76.1 (SEM 0.11) (65+) | 65.9 | prospective | database with presented symptoms recorded as freetext: Dutch synonyms for dizziness | 1,2 | |
Ekvall 2004 [16] | 1998 and 2000 | Sweden | 2 health care centres (14 GPs) | 311 | range 12-94 | 74.9a | retrospective | ICD9/10: 780.4 / R 42 and 386 / H81 | 1 | |
Ekvall 2005 [3] | 01/2003 - 12/2003 | Sweden | 6 primary health care centres | prev: 197 aet: 38 | prev: range 65-99 aet: Median 83 (65-94) | prev: 70.1a aet: 65.8a | prev: retrospective aet: prospective | prev: 65 years or older diagnosis R42 (ICD 10) aet: study participants; ICD 10 Code R 42 | 1,2 | |
Fink 2007 [40] | 10/1989 - 09/1999 | Austria | 1 general practitioner | 408a | n.r. | n.r. | prospective | all Episodes of Cares: dizziness as reason for encounter | 1 | |
Garrigues 2008 [41] | 11/2003 - 11/2004 | Spain | 6 primary care centres | 191 | 55.8 (SD 17.6) (range 10+) | 68.6 | prospective | vertigo crisis (illusion of unequivocal rotary movement) | under 10 years | 1 |
Gerber 1992 [42] | 15 months | USA | general internal medicine group practice (4 general internists) | 46 | range 18+ | n.r. | prospective | all physical complaints reported complaint of dizziness | 1 | |
Hanley 2002 [43] | 10/1999 - 03/2000 | Ireland | 13 general practitioners | 70 | n.r. | n.r. | prospective | vertigo (do you see the world spin around you as if you had got off a playground roundabout) | 2 | |
Harding 1980 [44] | n.r. | Colombia, India, Sudan, Philippines | primary health facilities | 90 | range 16+ | n.r. | prospective | reason for encounter of all patients aged 16 or older: dizziness | so seriously ill or required such urgent medical care that it would be unreasonable to administer the research questionnaires pat. Who refused to take part pat. Who had already attended once | 1 |
Hopkins 1989 [45] | 1981 - 1982 | Great Britain | 48 general practices (143 doctors) | n.r. | n.r. | n.r. | unclear | patients consulting for ICD 9: 780.4 and 386 | 1 | |
Jayarajan 2003 [14] | 08/2000 - 07/2001 | Great Britain | 53 general practitioners | 62,6 average (3318) | range 5+ 5-20: 1.3% 20-40: 13.5% 40-60: 24.7% 60-80: 40.5% > 80: 20% | n.r. | retrospective | dizziness | 1 | |
Kroenke 1989 [25] | 08/1984 – 07/1987 | USA | Internal Medicine clinic at Brooke Army Medical Center (primary care) | 55 | n.r. | n.r. | retrospective | dizziness (new complaint or recurrent complaint that prompted a new diagnostic workup) | chronic dizziness | 1,2,3 |
Kroenke 1998 [26] | n.r. | USA | Walter Reed Army Medical Center general medicine walk-in clinic | 30 | adults | n.r. | prospective | adult outpatients presenting with physical complaints (excl. Upper respiratory infection) dizziness | 3 | |
Kwong 2005 [4] | 02/2001 – 01/2003 | Canada | 1 family practice center | 50 | range 65-91 < 80: 38% > = 80 62% | 58 | retrospective | ICD 9 code of “780” (dizziness) 65 years of age or older random sample of eligible charts | Patients who are discharged from service or died | 2 |
Lawson 1999 [35] | a 3 month period | Great Britain | general practitioners from 4 practices | 50 | 74 (61-78) | 74a | prospective | patients presenting with dizziness more than 60 years of age | 1,2 | |
06/2006 - 01/2008 | Netherlands | 45 family physicians in 24 family practices | 417 | 78.5 (65-95) | 74 | prospective | dizziness being present for at least 2 weeks main reason for consultation 65 years or older | inability to speak Dutch or English, severe cognitive impairment, severe visual impairment (i.e. corrected visual acuity of less than 3/60 for the best eye), severe hearing impairment (i.e. verbal communication impossible), wheelchair dependency | 2,3 | |
Mash 2012 [46] | n.r. | South Africa | 240 health workers (nurses saw 86,1% of the patients) in mobile clinics, fixed clinics and community health centres | 299 | n.r. | n.r. | prospective | all patients contacts ICPC: Reason for encounter N17 – vertigo/ dizziness | 1 | |
MedViP 2008 [47] | 04/2001 - 12/2002 | Germany | 138 primary care practices | 10,871 | 59 | 67.2 | retrospective | ICD 10 Codes (H81, H82, A88, R42) dizziness medication synonyms for dizziness diagnoses | 1,2 | |
1 year | Great Britain | 1 general practice (3 doctors) | 74 | 0-4: 1.4a % 5-14: 10.8a % 15-24: 17.6a % 25-44: 21.6a % 45-64: 25.7a % > 65: 23.0a % | 70.3a | prospective | patients with a new symptom (which had not been presented to any doctor in the previous 12 months) disturbance of balance | 1,2 | ||
NAMCS 1989 [50] | 1981 and 1985 | USA | family physicians, general practitioners and general internists | 531 | 61.3 (25+) | 66.7 | prospective | all patients contacts Reason for encounter: S225.0 vertigo – dizziness | 1 | |
01-06 and 08-10 1991 | USA | 4 family group practices, 1 internal medicine group practice, 1 university family practice center, 1 solo general internist, 1 solo family physician, 1 county hospital emergency department | 142 | 58.6 (17-90) > 60: 59.2% < 60: 40.8% | 71.8 | prospective | dizziness as chief complaint or part of a symptom complex that represented the principal reason for visit at least 18 years | 2,3 | ||
Rieger 2014 [52] | 01/2008 - 12/2008 | Germany | general practitioners | 489598a | range 18-74 | n.r. | retrospective | ICD H81, H82, R42, A88.1, E53.8, F45.8, G11.8, G43.1, G45.0-, G62, G63, G90.3, H55, H83.0– 2, I95.1, N95.1 and R26 without R26.1 | 1 | |
Sicras 2007 [17] | 2006 | Spain | 5 primary health care centers | 6504 | n.r. | n.r. | retrospective | ICPC diagnosis N17 vertigo/ dizziness | 1 | |
Sczepanek 2011 [24] | n.r. | Germany | 21 primary care practices | 69 | 76.19 (SD 6.64) (range 65-95) | 69.6 | prospective | incident dizziness (less than six months) as main reason for encounter age at least 65 years | insufficient command of the German language, dementia, terminal diseases | 2,3 |
Transition Project 2012 [53] | 1995 - 2005 | Netherlands, Malta, Serbia | 59 general practices (69 doctors) | n.r. | n.r. | n.r. | prospective | all patients contacts ICPC: Reason for encounter N17 – vertigo/ dizziness | 1 | |
Wun 2000 [19] | 12/1997 - 03/1998 | China | 28 commune clinics = general practice clinics (42 primary care doctors) | 1331 | 60.8 (SD 13.5) | n.r. | prospective | all patients contacts ICPC: Reason for encounter N17 – vertigo/ dizziness | 1 | |
Yardley 1998 [22] | n.r. | Great Britain | 10 general practices | aet: 143 prog: 76 | aet: 59.8a(18+) prog: 59.6a | aet: 80.4a prog: 82.9a | aet: retrospective prog: prospective | study participants 18 years and older with a complaint of dizziness patient still symptomatic | non-vestibular cause for dizziness performance of vigorous head or body movements during exercise therapy was contraindicated multiple, life-threatening or progessive central disorders | 2,3 |
Yardley 2004 [21] | 2001 - 2002 | Great Britain | 20 general practices | aet: 170 prog: 87 | aet: 61.9a(18+) prog: 61.0 SD 14.42 | aet: 71 prog: 71 | aet: retrospective prog: prospective | study participants 18 years and older with a complaint of dizziness | Patients no longer found to be dizzy duration of dizziness less than 2 months during the past 2 years nonlabyrinthine cause of dizziness in patient records, none of the rehabilitation exercises provoked dizziness, medical contraindications for making required head movements serious comorbid conditions | 2,3 |
Yardley 2012 [20] | 10/2008 - 07/2009 | Great Britain | 35 general practices | 112 | 58.2 (18 +) | 75 | prospective | study participants 18 years and older with a complaint of dizziness during the past two years | patients who were no longer dizzy, non vestibular causes of dizziness, dizziness was not aggravated by rapid head movements, contraindications to treatment by vestiublar rehabilitation inability to speak English | 3 |
Quality of included studies
Study | Domain A: selection of patients and GPs | Domain B: Data collection and patient flow | Domain C. diagnostic work-up | Domain D: prognostic work-up |
---|---|---|---|---|
BEACH | low | low | n.r. | n.r. |
Bird 1998 | ? | ? | high | n.r. |
CONTENT | low | low | n.r. | n.r. |
DNSGP-2 | low | low | high | n.r. |
Ekvall 2004 | high | high | n.r. | n.r. |
Ekvall 2005 | high | high | high | n.r. |
Fink 2007 | high | low | n.r. | n.r. |
Garrigues 2008 | low | low | n.r. | n.r. |
Gerber 1992 | high | low | n.r. | n.r. |
Hanley 2002 | low | low | ? | n.r. |
Harding 1980 | low | low | n.r. | n.r. |
Hopkins 1989 | high | high | n.r. | n.r. |
Jayarajan 2003 | high | high | n.r. | n.r. |
Kroenke 1989 | high | high | high | high |
Kroenke 1998 | low | low | n.r. | ? |
Kwong 2005 | ? | high | high | n.r. |
Lawson 1999 – prev. | ? | low | n.r. | n.r. |
Lawson 1999 – aet.
| low | low | low | n.r. |
Maarsingh 2010 | low | low | low | low |
Mash 2012 | low | low | n.r. | n.r. |
MedViP –prev. | low | high | n.r. | n.r. |
MedViP –aet.
| high | high | high | n.r. |
Morrell 1972 | ? | low | high | n.r. |
NAMCS | low | low | n.r. | n.r. |
PCD | low | low | ? | ? |
Rieger 2014 | high | high | n.r. | n.r. |
Sczepanek 2011 | low | low | high | low |
Sicras 2007 | high | high | n.r. | n.r. |
Transition Project | low | low | n.r. | n.r. |
Wun 2000 | low | low | n.r. | n.r. |
Yardley 1998 | high | high | high | low |
Yardley 2004 – aet. | high | high | high | n.r. |
Yardley 2004 – prog.
| high | low | n.r. | low |
Yardley 2012 | high | low | n.r. | low |
Prevalence of the symptoms “dizziness” and “vertigo” in primary care
Aetiologies of the symptoms “dizziness” and “vertigo” in primary care
Dizziness | ||||
Aetiology | Number of studies | Number of patients | Results (range) | Heterogeneity I2 (95% CI)/prediction interval |
Otologic peripher | 10 | 10,658 | 5,4-42,1% | 95.5% (93.4-96.9%) 7.7-51.6% |
BPPV (subcategory) | 6 | 7956 | 4,3-39,5% | 93.2% (88.0-96.2%) 0.5-73.8% |
Vestibular neuritis (subcategory) | 6 | 7956 | 0,6-24,0% | 98.4% (97.6-98.9%) 0.0-98.6% |
Ménière’s disease (subcategory) | 4 | 7802 | 1,4-2,7% | 0.0% (0.0-0.0%) 1.4-2.8% |
Cardiovascular | 8 | 3011 | 3,8-56,8% | 98.5% (98.0-98.9%) 0.4-89.1% |
Neurological central | 9 | 10,620 | 1,4-11,4% | 78.7% (60.0-88.7%) 2.1-12.7% |
Psychogenic | 8 | 3016 | 1,8-21,6% | 88.5% (79.7-93.5%) 1.1-31.2% |
No specific diagnosis | 11 | 10,713 | 0,0-80,2% | 99.4% (99.3-99.5%) 1.6-90.5% |
Vertigo | ||||
Aetiology | Number of studies | Number of patients | Results (range) | Heterogeneity I2 /prediction interval |
Otologic peripher | 3 | 383 | 27.3-92.9% | 96.2% (91.8-98.2%) 0.0-100.0% |
BPPV (subcategory) | 3 | 383 | 4.9-42.9% | 96.4% (92.5-98.3%) 0.0-100.0% |
Vestibular neuritis (subcategory) | 3 | 383 | 8.4-40.0% | 94.3% (86.8-97.6%) 0.0-100.0% |
Ménière’s disease(subcategory) | 3 | 383 | 4.2-10.0% | 43.5% (0.0-83.1%) 0.0-94.1% |
Cardiovascular | 0 | |||
Neurological central | 1 | 70 | 4.3% | n/a |
Psychogenic | 1 | 70 | 1.4% | n/a |
No specific diagnosis | 3 | 383 | 1.4-72.7% | 92.3% (80.7-96.9%) 0.0-100.0% |
Maarsingh 2010 | Lawson 1999 | |
---|---|---|
Peripheral vestibular | 14.4% [11.2; 18.2] | 34.0% [21.6; 48.9] |
BPPV | 8.0% [2.6; 20.1] | |
Vestibular neuritis | 24.0% [13.5; 38.5] | |
Morbus Meniere | – | 2.0% [0.1-12.0] |
Cardiovascular | 56.8% [51.9; 61.6]a | 48.0% [33.9; 62.4] |
Neurological central | 2.9% [1.6; 5.1]b | 10.0% [3.7; 22.6] |
Cerebrovascular | – | 4.0% [0.7; 14.9] |
Psychogenic | 9.8% [7.2; 13.2] | – |
Musculosceletal | 3.6% [2.1; 6.0] | 4.0% [0.7; 14.9] |
Other internistic diseases | 0.7% [0.2; 2.3] | – |
Drug effects | 2.4% [1.2; 4.5] | – |
Other | 1.2% [0.4; 2.9] | – |
No specific diagnosis | 8.2% [5.8; 11.3] | 22.0% [12.0; 36.3] |