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Development of a Statistical Model for the Prediction
of Common Vestibular Diagnoses
David R. Friedland, MD, PhD; Sergey Tarima, PhD; Christy Erbe, BS; Alexia Miles, MPT
IMPORTANCE Treatment of patients with vestibular disorders can be complex, requires
lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter
intake questionnaire may predict the most common disorders, allowing for more efficient
allocation of resources and use of clinicians.
OBJECTIVE To develop a statistical model for predicting vestibular diagnoses, prior to clinical
evaluation, from an intake questionnaire.
DESIGN, SETTING, AND PARTICIPANTS Retrospective review of 414 consecutive new vestibular
patient intake questionnaires (September 2012 through January 2014) and associated
medical records with performance of logistic regression analyses and development of
predictive models (July 2013 through May 2015).
INTERVENTIONS Use of a vestibular intake questionnaire for triaging of new patients with
complaints of dizziness.
MAIN OUTCOMES AND MEASURES Predictors for the diagnosis of benign paroxysmal
positional vertigo (BPPV), Ménière’s disease, and vestibular migraine.
RESULTS Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary
to define a final diagnosis. Patients were 34%male and had a mean (range) age of 57 (19-91)
years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's
disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%)
of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The
diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and
specificity of 65%. The diagnosis of Ménière’s disease could be predicted from 5 variables
with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be
predicted from 4 variables with a sensitivity of 76% and specificity of 59%.
CONCLUSIONS AND RELEVANCE A pre-encounter history questionnaire can provide useful
diagnostic information for common vestibular disorders. This can help direct appointment
scheduling to improve clinical efficiency, time to intervention, and use of resources. Further
refinement may enable the use of shorter questionnaires or screening algorithms.
JAMA Otolaryngol Head Neck Surg. 2016;142(4):351-356. doi
Published online February 25, 2016.
Author Affiliations: Department of
Otolaryngology and Communications
Sciences, Medical College of
Wisconsin, Milwaukee (Friedland,
Erbe); Institute for Health and
Society, Division of Biostatistics,
Medical College of Wisconsin,
Milwaukee (Tarima); Froedtert
Hospital, Milwaukee, Wisconsin
(Miles).
Corresponding Author: David R.
Friedland, MD, PhD, Department of
Otolaryngology and Communication
Sciences, Medical College of
Wisconsin, 9200 WWisconsin Ave,
Milwaukee, WI 53226
.
Research
Original Investigation
Reprinted by permission of JAMA Otolaryngol Head Neck Surg. 2016; 142(4):351-356.
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