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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, 16–19, 21–24]

          

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

[16–19, 21–23]

13

3

0

3

I

     

6. Blood pressure

[17–19, 21–24]

16

0

0

-

I

     

7. Orthostatic hypotension

test[17–19, 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[16–19, 21–24]

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

[31–33, 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).
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BMC Primary Care

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