A digital neurotology history: Characteristics and inter-rater reliability
Miranda Morrison1, Sally M Rosengren1,2, Diego Herrero1
1Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Purpose:
Dizziness is a common presenting symptom that is often misdiagnosed. The first step towards diagnosis of the underlying vestibular disorder is recognition of the vestibular syndrome, after which targeted examination and testing provide the diagnosis. We therefore developed and evaluated a digital history tool to aid clinicians in selecting the correct vestibular syndrome.
Method:
We administered a 21-item symptom questionnaire to 201 patients at a tertiary-referral outpatient clinic and 54 patients in an emergency department. Two clinicians classified each patient with one or more of four syndromes: acute vestibular syndrome (AVS), episodic positional vertigo (EPV), episodic spontaneous vertigo (ESV) or chronic vestibular syndrome (CVS). We assessed inter-rater agreement in both locations and compared the syndromic diagnosis with a gold standard diagnosis in the outpatient clinic.
Results:
Inter-rater agreement was 0.66 in the outpatient clinic and 0.78 in emergency (Cohen's κ, p < 0.001). In outpatients, gold standard syndromic diagnoses were 11 AVS, 57 EPV, 88 ESV and 45 CVS. Sensitivity was greatest for ESV (86.4%), and moderate for AVS (54.5%), EPV (71.9%) and CSV (62.2%). Automated classification using if/then rules and logistic regression analyses produced similar outcomes.
Conclusion:
Our history tool provided good reproducibility and accuracy in syndromic classification, showing promise for translation to frontline settings.
