Predicting an unfavorable course of dizziness in older patients

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

PURPOSE Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool. METHODS We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] ≥30), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI ≥30) after 6 months. RESULTS Prevalence of an unfavorable course of dizziness was 73.9% in the development cohort and 43.6% in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice. CONCLUSIONS We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.

Original languageEnglish
Pages (from-to)428-435
Number of pages8
JournalAnnals of Family Medicine
Volume16
Issue number5
DOIs
Publication statusPublished - 1 Sep 2018

Cite this

@article{b19dd1a46e6245238e7b3a3c6d69624a,
title = "Predicting an unfavorable course of dizziness in older patients",
abstract = "PURPOSE Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool. METHODS We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] ≥30), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI ≥30) after 6 months. RESULTS Prevalence of an unfavorable course of dizziness was 73.9{\%} in the development cohort and 43.6{\%} in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice. CONCLUSIONS We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.",
keywords = "Dizziness, Falls, Geriatrics, Older adults, Practice-based research, Primary care, Risk factors, Risk prediction",
author = "Hanneke Stam and Maarsingh, {Otto R.} and Heymans, {Martijn W.} and {van Weert}, {Henk C.P.M.} and {van der Wouden}, {Johannes C.} and {van der Horst}, {Henri{\"e}tte E.}",
year = "2018",
month = "9",
day = "1",
doi = "10.1370/afm.2289",
language = "English",
volume = "16",
pages = "428--435",
journal = "Annals of Family Medicine",
issn = "1544-1709",
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Predicting an unfavorable course of dizziness in older patients. / Stam, Hanneke; Maarsingh, Otto R.; Heymans, Martijn W.; van Weert, Henk C.P.M.; van der Wouden, Johannes C.; van der Horst, Henriëtte E.

In: Annals of Family Medicine, Vol. 16, No. 5, 01.09.2018, p. 428-435.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Predicting an unfavorable course of dizziness in older patients

AU - Stam, Hanneke

AU - Maarsingh, Otto R.

AU - Heymans, Martijn W.

AU - van Weert, Henk C.P.M.

AU - van der Wouden, Johannes C.

AU - van der Horst, Henriëtte E.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - PURPOSE Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool. METHODS We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] ≥30), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI ≥30) after 6 months. RESULTS Prevalence of an unfavorable course of dizziness was 73.9% in the development cohort and 43.6% in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice. CONCLUSIONS We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.

AB - PURPOSE Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool. METHODS We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] ≥30), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI ≥30) after 6 months. RESULTS Prevalence of an unfavorable course of dizziness was 73.9% in the development cohort and 43.6% in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice. CONCLUSIONS We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.

KW - Dizziness

KW - Falls

KW - Geriatrics

KW - Older adults

KW - Practice-based research

KW - Primary care

KW - Risk factors

KW - Risk prediction

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U2 - 10.1370/afm.2289

DO - 10.1370/afm.2289

M3 - Article

VL - 16

SP - 428

EP - 435

JO - Annals of Family Medicine

JF - Annals of Family Medicine

SN - 1544-1709

IS - 5

ER -