Skip to main content

Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Table 2 Results of the Delphi Procedure

From: Development of a diagnostic protocol for dizziness in elderly patients in general practice: a Delphi procedure

Diagnostic test
(N = 36+1)
First round Second round Consensus round†
  Inclusion Exclusion No expertise Most important motivation for exclusion* Result† Inclusion Exclusion No expertise Result† Result†
I. Patient History[6, 1619, 2124]           
1. Present dizzy symptoms 16 0 0 - I      
2. Medication 16 0 0 - I      
3. Alcohol intake 15 1 0 2,5 I      
4. Medical history 16 0 0 - I      
II. Physical Examination           
Cardiovascular System           
5. Pulse Measurement
[1619, 2123]
13 3 0 3 I      
6. Blood pressure
[1719, 2124]
16 0 0 - I      
7. Orthostatic hypotension
test[1719, 21, 23, 24, 27, 28]
10 6 0 1,3 2 10 6 0 C I
8. Orthostatic test[58]‡ 7 8 1 1 2 3 13 0 E  
9. Auscultation of the heart[1619, 2124] 14 2 0 2,3 I      
10. Auscultation of the carotids[18, 24, 49, 51] 9 7 0 2 2 10 6 0 C E
Extra test, added after round 1:           
   Alternative orthostatic test§       2 12 2 E  
Locomotor System           
11. Orthopaedic screening of lower extremities[21, 22, 24] 9 3 4 3 I      
12. Toe and heel gait[22] 6 7 3 2,3 2 5 8 3 C E
13. One-leg stance test[21, 37] 2 9 5 3 E      
14. Tandem gait[21, 22, 24, 37] 10 3 3 2 I      
15. Performance-oriented mobility assessment[41, 63]‡ 1 10 5 1 E      
16. Berg Balance Scale
[3133, 35, 36]‡
5 5 7 3 2 3 8 5 E  
17. The timed 'up and go'-test
[21, 22, 55, 59]
5 5 6 2 2 5 6 5 C E
Neurological System           
18. Tendon reflexes[22, 24] 11 2 3 1,2,3 I      
19. Semmes-Weinstein
Monofilament Test[71, 72]‡
7 5 4 3 2 7 5 4 C I
Vestibular System           
20. Otoscopy[17, 21, 22, 24] 10 3 3 2,3 I      
21. Dix-Hallpike Maneuver
[17, 20, 24, 30, 34]
10 3 3 1,2 I      
22. Side-lying[42]‡ 5 8 3 2 2 2 11 3 E  
23. Head-shaking Nystagmus [20, 39, 45, 46, 48, 50, 62, 64, 65] 4 9 3 1,2 2 0 12 4 E  
24. Vibration-induced
nystagmus[20, 44, 47, 57]
2 11 3 1 E      
Remaining Tests           
25. Visual acuity[20, 22] 11 2 3 1,3 I      
III. Additional Tests           
Cardiovascular System           
26. Electrocardiogram
[16, 18, 19, 21, 23, 24]
13 2 1 1,2,3,4 I      
27. Carotid sinus massage [19, 23, 40, 43, 49, 51, 52, 56, 66] 3 11 2 1 E      
28. ECG-monitoring [18, 19, 23, 29, 38, 53, 54, 60, 61, 67] 10 5 1 1 2 13 2 1 I  
Laboratory Tests[24, 69]           
29. Erythrocyte
sedimentation rate[24]
7 7 2 3 2 6 9 1 C E
30. Haemoglobin[24] 13 1 2 3 I      
31. Non-fasting blood
glucose‡
12 2 2 3 I      
32. Serum potassium level‡ 9 5 2 3 2 11 4 1 I E||
33. Serum sodium level‡ 8 6 2 3 2 10 5 1 C E
34. Thyroid function‡ 6 7 3 3 2 5 9 2 C E
Psychiatric Testing           
35. Patient Health Questionnaire[68]‡ 8 4 4 1,2 2 9 4 3 C I
Vestibular System           
36. Audiometry[17, 21, 22, 24, 26] 9 4 3 1 2 10 3 3 I  
  1. *: 1: Technical feasibility; 2: Diagnostic accuracy; 3: Diagnostic thinking impact; 4: Therapeutic choice impact; 5: Patient outcome impact; 6: Societal impact †: I: Inclusion; E: Exclusion; 2: Second round; C: Consensus round; the threshold for respectively in- or exclusion was set at an agreement of ≥70% ‡: Not recommended by any practice guideline on dizziness, syncope, or vertigo §: Blood pressure measurement after 5 min of lying supine, followed by measurement after standing for 5 min or when orthostatic symptoms do occur; decrease in systolic blood pressure ≥ 20 mmHg or a decrease of systolic blood pressure to < 90 mmHg is defined as orthostatic hypotension ║: Eventually removed, because of the lack of evidence, and the high chance of false-positives, in combination with the impact for the patient (intra-venous puncture).