Abstract
BackgroundDizziness is a common reason for consulting a general practitioner and there is a broad range of possible underlying aetiologies. There are few evidence-based data about prevalence, aetiology and prognosis in primary care. We aimed to conduct a systematic review of symptom-evaluating studies on prevalence, aetiology or prognosis of dizziness in primary care.MethodsWe systematically searched MEDLINE and EMBASE. Two independent researchers screened titles and abstracts according to predefined criteria. We included all studies evaluating the symptoms ‘dizziness’ or ‘vertigo’ as a reason for consultation in primary care. We extracted data about study population and methodology and prevalence, aetiology and prognosis. Two raters independently judged study quality and risk of bias. We investigated the variation across studies using forest plots, I2 and prediction intervals. Since we anticipated a great amount of clinical and unexplained statistical heterogeneity, we provided qualitative syntheses instead of pooled estimates.ResultsWe identified 31 studies (22 on prevalence, 14 on aetiology and 8 on prognosis). Consultation prevalence differs between 1,0 and 15,5%. The most common aetiologies are vestibular/peripheral (5,4-42,1%), benign peripheral positional vertigo (4,3-39,5%), vestibular neuritis (0,6-24,0%), Menière’s disease (1,4-2,7%), cardiovascular disease (3,8-56,8%), neurological disease (1,4-11,4%), psychogenic (1,8-21,6%), no clear diagnosis (0,0-80,2%). While studies based on subjective patient assessment reported improvement rates from 37 to 77%, these findings could not be confirmed when applying instruments that measure symptom severity or quality of life.ConclusionThere is a broad variety of possible underlying diseases for the symptom dizziness. There exist only few methodologically sound studies concerning aetiology and prognosis of dizziness.
Highlights
Dizziness is a common reason for consulting a general practitioner and there is a broad range of possible underlying aetiologies
While dizziness is a more subjective and vague symptom referring to a sense of spatial disorientation, motion of the environment, or light headedness, vertigo is described as an illusion of movement, either of the external world revolving around the individual or
In comparison to different specialists like neurologists, Ear Nose and Throat (ENT) doctors or cardiologists who would only provide a workup for selected underlying diseases, general practitioner (GP) are trained to identify the whole range of possible aetiologies for the symptom dizziness
Summary
Dizziness is a common reason for consulting a general practitioner and there is a broad range of possible underlying aetiologies. While dizziness is a more subjective and vague symptom referring to a sense of spatial disorientation, motion of the environment, or light headedness, vertigo (as a subcategory of dizziness) is described as an illusion of movement, either of the external world revolving around the individual or Dizziness affects patients in many ways. Hereby it is not always necessary to make an exact diagnosis as GPs in their role as gatekeepers first of all need to identify patients with uncomplicated diseases (which are often self-limiting, needing only symptomatic relief ) while not overseeing potential serious diseases, which need further investigation and at times immediate therapy In this process, GPs base their decisions predominantly on history and clinical examination. Because of already selected patients and resulting differing pre-test probabilities, data generated in secondary care are not applicable for the primary care context
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