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Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results
BACKGROUND: Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. AIM: To examine the dia...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527447/ https://www.ncbi.nlm.nih.gov/pubmed/34669009 http://dx.doi.org/10.1007/s00415-021-10829-7 |
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author | Bamiou, Doris-Eva Kikidis, Dimitris Bibas, Thanos Koohi, Nehzat Macdonald, Nora Maurer, Christoph Wuyts, Floris L. Ihtijarevic, Berina Celis, Laura Mucci, Viviana Maes, Leen Van Rompaey, Vincent Van de Heyning, Paul Nazareth, Irwin Exarchos, Themis P. Fotiadis, Dimitrios Koutsouris, Dimitrios Luxon, Linda M. |
author_facet | Bamiou, Doris-Eva Kikidis, Dimitris Bibas, Thanos Koohi, Nehzat Macdonald, Nora Maurer, Christoph Wuyts, Floris L. Ihtijarevic, Berina Celis, Laura Mucci, Viviana Maes, Leen Van Rompaey, Vincent Van de Heyning, Paul Nazareth, Irwin Exarchos, Themis P. Fotiadis, Dimitrios Koutsouris, Dimitrios Luxon, Linda M. |
author_sort | Bamiou, Doris-Eva |
collection | PubMed |
description | BACKGROUND: Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. AIM: To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. METHODS: Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (− DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the “gold standard” against which the + DSS, − DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. RESULTS: One hundred ninety-four participants (age range 25–85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the − DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the − DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the − DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group. CONCLUSION: There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. TRIAL REGISTRATION NUMBER: NCT02704819 (clinicaltrials.gov). |
format | Online Article Text |
id | pubmed-8527447 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-85274472021-10-20 Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results Bamiou, Doris-Eva Kikidis, Dimitris Bibas, Thanos Koohi, Nehzat Macdonald, Nora Maurer, Christoph Wuyts, Floris L. Ihtijarevic, Berina Celis, Laura Mucci, Viviana Maes, Leen Van Rompaey, Vincent Van de Heyning, Paul Nazareth, Irwin Exarchos, Themis P. Fotiadis, Dimitrios Koutsouris, Dimitrios Luxon, Linda M. J Neurol Original Communication BACKGROUND: Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. AIM: To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. METHODS: Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (− DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the “gold standard” against which the + DSS, − DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. RESULTS: One hundred ninety-four participants (age range 25–85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the − DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the − DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the − DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group. CONCLUSION: There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. TRIAL REGISTRATION NUMBER: NCT02704819 (clinicaltrials.gov). Springer Berlin Heidelberg 2021-10-20 2022 /pmc/articles/PMC8527447/ /pubmed/34669009 http://dx.doi.org/10.1007/s00415-021-10829-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Communication Bamiou, Doris-Eva Kikidis, Dimitris Bibas, Thanos Koohi, Nehzat Macdonald, Nora Maurer, Christoph Wuyts, Floris L. Ihtijarevic, Berina Celis, Laura Mucci, Viviana Maes, Leen Van Rompaey, Vincent Van de Heyning, Paul Nazareth, Irwin Exarchos, Themis P. Fotiadis, Dimitrios Koutsouris, Dimitrios Luxon, Linda M. Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
title | Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
title_full | Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
title_fullStr | Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
title_full_unstemmed | Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
title_short | Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
title_sort | diagnostic accuracy and usability of the embalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results |
topic | Original Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527447/ https://www.ncbi.nlm.nih.gov/pubmed/34669009 http://dx.doi.org/10.1007/s00415-021-10829-7 |
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