Clinical factors modestly accurate in predicting poor outcomes in older patients with dizziness (RODEO)

Reference

Stam H, Maarsingh OR, Heymans MW, van Weert HC, van der Wouden JC, van der Horst HE. Predicting an unfavorable course of dizziness in older patients. Ann Fam Med 2018;16(5):428-435.

Synopsis

These authors started this project by searching already-published research to identify 67 variables that were potentially associated with long-term outcomes in patients with dizziness. These variables were pulled from several instruments and were clustered into 3 domains: demographics, health status, and dizziness. One set of variables came from the Dizziness Handicap Inventory [DHI] score, a 25-item scale that also has a 10-item screening subscale (see below). The authors then recruited a cohort of 203 patients, 65 years or older, with dizziness for participation in the Reduction Of Dizziness in older pEOple (RODEO) study. The patients came from 45 primary care practices in the Netherlands and were followed up for 6 months. The authors used the full DHI score as the basis for the main outcome at 6 months: substantial dizziness-related impairment as determined by a DHI score of 30 or higher. The researchers applied elements of the aforementioned variables, scales, and subscales to their RODEO cohort to see which combinations correlated best with outcome. They then validated this model in an independent cohort of patients: 415 participants in the Dizziness in Elderly Patients (DIEP) study. At the end of 6 months, three-fourths of the RODEO participants had substantial dizziness impairment compared with not quite half of the DIEP participants. The final model score is the sum of the patient's age plus double the DHI screening score plus 11 points if the patient has a history of arrhythmia and another 11 points if the symptoms are provoked by looking up. A score of 134 or higher is predictive of an unfavorable course. In the validation cohort, the final model was 78% accurate. DHI screening subscale (from Jacobson GP, Calder JH. Am J Otol 1998;19:804-808): • Because of your problem, do you feel depressed? • Does walking down a sidewalk increase your problem? • Because of your problem, is it difficult to concentrate? • Because of your problem, is it difficult to walk around your house in the dark? • Does bending over increase your problem? • Because of your problem, do you restrict your travel for business or recreation? • Does your problem interfere with your job or household responsibilities? • Because of your problem, are you afraid to leave your home without having someone accompany you? • Because of your problem, have you been embarrassed in front of others? • Does your problem significantly restrict your participation in social activities such as going out to dinner, going to the movies, dancing, or to parties? Scoring: 1 point for every yes.