Imprecision in patient reports of dizziness symptom quality: A cross-sectional study conducted in an acute care setting
Imprecision in patient reports of dizziness symptom quality: A cross-sectional study conducted in an acute care setting
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DOI：
10.4065/82.11.1329
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发表时间：
2007-11-01
影响因子：
8.9
通讯作者：
Zee, David S.
中科院分区：
文献类型：
--
作者：
Newman-Toker, David E.;Cannon, Lisa M.;Zee, David S.
目的：量化不同头晕属性患者报告的准确性。患者和方法：在一项横断面研究中，我们采访了2005年7月2日至2005年8月26日在2个城市学术急诊科（ed）连续就诊的头晕成年患者。我们排除了病情严重无法接受访谈或对访谈者构成风险的患者。我们纳入了那些“头晕、头晕或失去平衡”持续7天或更少的人，或者以前被同样的条件“困扰”的人。我们评估了由4个不同格式的问题（开放式、多回答、单选择和定向）引起的头晕质量描述。清晰度定性评估（模糊，圆形）和定量评估（头晕类型重叠）。一致性通过跨问题格式的不匹配回答的频率来衡量。通过重测确定信度。结果：在筛选的1342例患者中，872例（65%）在过去7天内出现头晕、头晕或不平衡（n=677）或之前有头晕困扰（n=195）。在872例头晕患者中，44%认为头晕是就诊的“主要原因”或“部分原因”。开放式的描述往往含糊不清或循环往复。在多回答问题中，62%的人选择了1种以上的头晕类型。在同样的问题上，54英寸/ 0没有选择之前在公开描述中认可的一种或多种类型。218名患者在前3个问题中没有确定眩晕、旋转或运动，70%的患者在定向询问中确认为旋转或运动。当被要求选择一个最佳描述时，52%的人在大约6分钟后的重新测试中选择了不同的回答。相比之下，头晕持续时间和诱因的报告清晰、一致和可靠。结论：对头晕质量的描述不明确、不一致、不可靠，使人们对传统方法治疗头晕患者的有效性产生怀疑。应该研究强调时间和触发因素而不是类型的替代方法。
OBJECTIVE: To quantify precision in patient reports of different attributes of dizziness.PATIENTS AND METHODS: In a cross-sectional study, we interviewed consecutive adult patients with dizziness at 2 urban academic emergency departments (EDs) from July 2, 2005, to August 26, 2005. We excluded patients who were too sick for an interview or who posed a risk to the interviewer. We included those who were "dizzy, light-headed, or off-balance" for 7 days or less or previously "bothered" by the same conditions. We assessed descriptions of dizziness quality elicited by 4 questions in different formats (open-ended, multiresponse, single-choice, and directed). Clarity was assessed qualitatively (vague, circular) and quantitatively (overlap of types of dizziness). Consistency was measured by frequency of mismatched responses across question formats. Reliability was determined by test-retest.RESULTS: Of 1342 patients screened, 872 (65%) were dizzy, lightheaded, or off-balance in the past 7 days (n=677) or previously bothered by dizziness (n=195). Among these 872 patients with dizziness, 44% considered dizziness "the main reason" or "part of the reason" for the ED visit. Open-ended descriptions were frequently vague or circular. A total of 62% selected more than 1 dizziness type on the multiresponse question. On the same question, 54"/o did not pick 1 or more types endorsed previously in open description. Of 218 patients not identifying vertigo, spinning, or motion on the first 3 questions, 70% confirmed "spinning or motion" on directed questioning. Asked to choose the single best descriptor, 52% picked a different response on retest approximately 6 minutes later. By comparison, reports of dizziness duration and triggers were clear, consistent, and reliable.CONCLUSION: Descriptions of the quality of dizziness are unclear, inconsistent, and unreliable, casting doubt on the validity of the traditional approach to the patient with dizziness. Alternative approaches, emphasizing timing and triggers over type, should be investigated.