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. 2025 Aug 2;26(1):238.
doi: 10.1186/s12875-025-02920-z.

Identifying tests to evaluate in a diagnostic accuracy study for patients with vertigo in general practice: a Delphi study

Anna-Marie R Leemeyer  1   2 , Andrew K Ross  1   2 , Tjasse D Bruintjes  3   4 , Jochen W L Cals  5 , Roeland B van Leeuwen  6 , Birgit I Lissenberg-Witte  7 , Vincent A van Vugt  1   2 , Otto R Maarsingh  8   9
Affiliations

Identifying tests to evaluate in a diagnostic accuracy study for patients with vertigo in general practice: a Delphi study

Anna-Marie R Leemeyer et al. BMC Prim Care. .

Abstract

Introduction: Vertigo is a common symptom that strongly impacts patients' quality of life. More than 80% of patients experiencing vertigo are primarily treated by their general practitioner (GP). The GP's'diagnostic toolkit' for vertigo has serious limitations, though, because diagnostic accuracy studies on conditions that may cause vertigo have never been performed in a general practice setting. Our aim was to determine which tests should be investigated in a diagnostic accuracy study for patients with vertigo in general practice.

Method: We conducted an online Delphi procedure involving national and international experts. The experts were asked to judge a selection of 40 diagnostic tests based on the Dutch GP guideline on vestibular symptoms, supplemented by tests identified during a systematic review. Panellists were allowed to suggest additional tests after the first round. In case of consensus of at least 70%, a test was included or excluded. We also conducted a secondary sub-analysis of our Delphi procedure to demonstrate non-dominance of Dutch experts within our expert panel. Data were analysed using descriptive statistics and content analysis. Data were analysed using descriptive statistics and content analysis.

Results: A panel of 20 experts from five countries, including 7 specialists in otolaryngology, 6 neurologists and 7 GPs, participated in the Delphi procedure. The panel judged 46 diagnostic tests in total, with 6 additional tests added to the original selection based on suggestions by experts. After the first two rounds (100% response rate), 16 tests were included, 22 tests were excluded and no consensus was reached on 8 tests. During the consensus round, one of the 8 tests was added to the included 16 tests. Of these 17 tests, 15 are recommended by the Dutch GP guideline, supplemented by the non-recommended Tandem walking test and the Romberg test.

Conclusions: An international expert panel reached consensus on 17 tests for vertigo in general practice that should be investigated in a diagnostic accuracy study.

Keywords: Consensus; Delphi technique; Dizziness; General practice; Primary Health Care; Vertigo.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval for this study was obtained from the Medical Ethics Review Committee of the Amsterdam UMC, VU University Medical Center (reference number: 2022.0390, approval date: 28 June 2022). Consent for publication: Informed consent was obtained from all experts by e-mail. The experts agreed to give their professional opinion Competing interests: The authors declare no competing interests.

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