{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:09Z","timestamp":1787017029854,"version":"build-2736575974"},"reference-count":54,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Dutch Organization for Health Research and Development","award":["10060022010003"],"award-info":[{"award-number":["10060022010003"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,18]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP\u2019s diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders (\u2018How well does test x discriminate between patients with or without target condition y?\u2019) has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) M\u00e9ni\u00e8re\u2019s disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence\/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817\u2014NL83111.029.22). We will publish our findings in peer-reviewed international journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN97250704\">ISRCTN97250704<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-085715","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T23:41:02Z","timestamp":1712101262000},"page":"e085715","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: study protocol"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"isrctn97250704","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2870-6032","authenticated-orcid":false,"given":"Andrew","family":"Ross","sequence":"first","affiliation":[{"name":"Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3600-1614","authenticated-orcid":false,"given":"Anna-Marie Rebecca","family":"Leemeyer","sequence":"additional","affiliation":[{"name":"Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjasse D","family":"Bruintjes","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands"},{"name":"Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9550-5674","authenticated-orcid":false,"given":"Jochen W L","family":"Cals","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolfo","family":"Bronstein","sequence":"additional","affiliation":[{"name":"Neuro-otology Unit, Division of Brain Sciences, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roeland B","family":"van Leeuwen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Lissenberg-Witte","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2746-4820","authenticated-orcid":false,"given":"Vincent Alexander","family":"van Vugt","sequence":"additional","affiliation":[{"name":"Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Rutgers","sequence":"additional","affiliation":[{"name":"Patient association Hoormij NVVS, Houten, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3747-9217","authenticated-orcid":false,"given":"Otto R","family":"Maarsingh","sequence":"additional","affiliation":[{"name":"Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands"},{"name":"Amsterdam Public Health Research Institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"key":"2025121603305985000_14.4.e085715.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2015.04.010"},{"key":"2025121603305985000_14.4.e085715.2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-63437-5.00006-6"},{"key":"2025121603305985000_14.4.e085715.3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3233\/VES-2004-14105","article-title":"Prevalence of dizziness and vertigo in an urban elderly population","volume":"14","author":"J\u00f6nsson","year":"2004","journal-title":"VES"},{"key":"2025121603305985000_14.4.e085715.4","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.19.2118"},{"key":"2025121603305985000_14.4.e085715.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13561-019-0258-2","article-title":"Economic burden of vertigo: a systematic review","volume":"9","author":"Kovacs","year":"2019","journal-title":"Health Econ Rev"},{"key":"2025121603305985000_14.4.e085715.6","first-page":"348","article-title":"Dutch guideline on dizziness. [NHG-Standaard Duizeligheid]","volume":"60","author":"Bouma","year":"2017","journal-title":"Huisarts Wet"},{"key":"2025121603305985000_14.4.e085715.7","first-page":"809","article-title":"Symptoms of vertigo in general practice: a prospective study of diagnosis","volume":"52","author":"Hanley","year":"2002","journal-title":"Br J Gen Pract"},{"key":"2025121603305985000_14.4.e085715.8","doi-asserted-by":"publisher","DOI":"10.3109\/02813432.2016.1160634"},{"key":"2025121603305985000_14.4.e085715.9","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.7.1.1"},{"key":"2025121603305985000_14.4.e085715.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-017-0695-0","article-title":"Prevalence, Aetiologies and prognosis of the symptom dizziness in primary care - a systematic review","volume":"19","author":"B\u00f6sner","year":"2018","journal-title":"BMC Fam Pract"},{"key":"2025121603305985000_14.4.e085715.11","doi-asserted-by":"crossref","first-page":"167","DOI":"10.3233\/VES-2012-0453","article-title":"Newman-Toker D: vestibular migraine: diagnostic criteria","volume":"22","author":"Lempert","year":"2012","journal-title":"J Vestib Res"},{"key":"2025121603305985000_14.4.e085715.12","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.080910"},{"key":"2025121603305985000_14.4.e085715.13","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M1124"},{"key":"2025121603305985000_14.4.e085715.14","first-page":"154","article-title":"Dizziness: approach to evaluation and management","volume":"95","author":"Muncie","year":"2017","journal-title":"Am Fam Physician"},{"key":"2025121603305985000_14.4.e085715.15","doi-asserted-by":"crossref","unstructured":"Kunnamo I . Evidence-Based Medicine Guidelines. John Wiley & Sons, 2005.","DOI":"10.1002\/0470027460"},{"key":"2025121603305985000_14.4.e085715.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.eupc.2004.08.008"},{"key":"2025121603305985000_14.4.e085715.17","first-page":"190","article-title":"An approach to vertigo in general practice","volume":"45","author":"Dommaraju","year":"2016","journal-title":"Aust Fam Physician"},{"key":"2025121603305985000_14.4.e085715.18","unstructured":"Vertigo. NICE Clinical Knowledge Summaries, Available: https:\/\/cks.nice.org.uk\/topics\/vertigo\/"},{"key":"2025121603305985000_14.4.e085715.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b3493"},{"key":"2025121603305985000_14.4.e085715.20","doi-asserted-by":"publisher","DOI":"10.3233\/VES-150553"},{"key":"2025121603305985000_14.4.e085715.21","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1097\/00129492-200403000-00008","article-title":"Side-lying as an alternative to the Dix-Hallpike test of the posterior canal","volume":"25","author":"Cohen","year":"2004","journal-title":"Otology & Neurotology"},{"key":"2025121603305985000_14.4.e085715.22","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0b013e31816f2820"},{"key":"2025121603305985000_14.4.e085715.23","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1288\/00005537-199411000-00012","article-title":"Diagnostic problems in patients with benign Paroxysmal Positional vertigo","volume":"104","author":"Norr\u00e9","year":"1994","journal-title":"Laryngoscope"},{"key":"2025121603305985000_14.4.e085715.24","doi-asserted-by":"crossref","DOI":"10.3310\/hta11500","article-title":"Evaluation of diagnostic tests when there is no gold standard. A review of methods","volume":"11","author":"Rutjes","year":"2007","journal-title":"Health Technol Assess"},{"key":"2025121603305985000_14.4.e085715.25","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1354598"},{"key":"2025121603305985000_14.4.e085715.26","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2296-11-2","article-title":"Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics","volume":"11","author":"Maarsingh","year":"2010","journal-title":"BMC Fam Pract"},{"key":"2025121603305985000_14.4.e085715.27","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1116"},{"key":"2025121603305985000_14.4.e085715.28","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003814"},{"key":"2025121603305985000_14.4.e085715.29","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.016979"},{"key":"2025121603305985000_14.4.e085715.30","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.h5527","article-title":"Stard 2015: an updated list of essential items for reporting diagnostic accuracy studies","volume":"351","author":"Bossuyt","year":"2015","journal-title":"BMJ"},{"key":"2025121603305985000_14.4.e085715.31","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.100420"},{"key":"2025121603305985000_14.4.e085715.32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3233\/VES-150549","article-title":"Diagnostic criteria for Meniere\u2019s disease","volume":"25","author":"Lopez-Escamez","year":"2015","journal-title":"J Vestib Res"},{"key":"2025121603305985000_14.4.e085715.33","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jclinepi.2020.06.021","article-title":"The 25-item dizziness handicap inventory was shortened for use in general practice by 60 percent","volume":"126","author":"van Vugt","year":"2020","journal-title":"J Clin Epidemiol"},{"key":"2025121603305985000_14.4.e085715.34","doi-asserted-by":"crossref","first-page":"578305","DOI":"10.3389\/fneur.2020.578305","article-title":"Upright BPPV protocol: feasibility of a new diagnostic paradigm for lateral semicircular canal benign Paroxysmal Positional vertigo compared to standard diagnostic maneuvers","volume":"11","author":"Martellucci","year":"2020","journal-title":"Front Neurol"},{"key":"2025121603305985000_14.4.e085715.35","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1007\/s00415-021-10627-1","article-title":"Capturing vertigo in the emergency room: three tools to double the rate of diagnosis","volume":"269","author":"Nham","year":"2022","journal-title":"J Neurol"},{"key":"2025121603305985000_14.4.e085715.36","first-page":"200","article-title":"De Pati\u00ebnt met Duizeligheid: Een Praktische Aanpak","volume":"109","author":"Leeuwen","year":"2008","journal-title":"Tijdschr Neurol En Neurochir"},{"key":"2025121603305985000_14.4.e085715.37","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3233\/VES-210022","article-title":"Subjective versus objective tests of dizziness and vestibular function in epidemiologic screening research","volume":"32","author":"Cohen","year":"2022","journal-title":"J Vestib Res"},{"key":"2025121603305985000_14.4.e085715.38","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1159\/000055771","article-title":"Vertigo and Electronystagmography in uni-and bilateral Meniere\u2019s disease","volume":"63","author":"Mateijsen","year":"2001","journal-title":"ORL J Otorhinolaryngol Relat Spec"},{"key":"2025121603305985000_14.4.e085715.39","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2478\/s13382-012-0002-1","article-title":"Electronystagmography versus Videonystagmography in diagnosis of vertigo","volume":"25","author":"Pietkiewicz","year":"2012","journal-title":"Int J Occup Med Environ Health"},{"key":"2025121603305985000_14.4.e085715.40","first-page":"89","article-title":"Do Frenzel glasses have a place in the modern Electronystagmography laboratory","volume":"17","author":"Ben-David","year":"1996","journal-title":"Am J Otol"},{"key":"2025121603305985000_14.4.e085715.41","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2377-10-98","article-title":"Diagnostic indices for Vertiginous diseases","volume":"10","author":"Bayer","year":"2010","journal-title":"BMC Neurol"},{"key":"2025121603305985000_14.4.e085715.42","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12223"},{"key":"2025121603305985000_14.4.e085715.43","unstructured":"Fleiss JL , Levin B , Paik MC . Statistical methods for rates and proportions. In: Statistical Methods for Rates and Proportions. New York: John Wiley & Sons Available. https:\/\/onlinelibrary.wiley.com\/doi\/book\/10.1002\/0471445428"},{"key":"2025121603305985000_14.4.e085715.44","doi-asserted-by":"crossref","unstructured":"Newcombe RG . Two-sided confidence intervals for the single proportion. Comparison of Seven Methods Statistics in Medicine;1998:17\u201316.","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E"},{"key":"2025121603305985000_14.4.e085715.45","unstructured":"Castor E . Castor electronic data capture, Available: https:\/\/castoredc.com\/"},{"key":"2025121603305985000_14.4.e085715.46","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4"},{"key":"2025121603305985000_14.4.e085715.47","doi-asserted-by":"crossref","unstructured":"Hosmer DW , Lemeshow S . Applied Logistic Regression. New York: John Wiley & Sons, 1989:135\u201375.","DOI":"10.2307\/2531779"},{"key":"2025121603305985000_14.4.e085715.48","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-301246"},{"key":"2025121603305985000_14.4.e085715.49","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-3-200402030-00010"},{"key":"2025121603305985000_14.4.e085715.50","doi-asserted-by":"crossref","DOI":"10.2307\/2529310","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"2025121603305985000_14.4.e085715.51","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012799","article-title":"De vet HC: STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration","volume":"6","author":"Cohen","year":"2016","journal-title":"BMJ Open"},{"key":"2025121603305985000_14.4.e085715.52","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-3-200602070-00009"},{"key":"2025121603305985000_14.4.e085715.53","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3233\/VES-201531","article-title":"The economic burden of vertigo and dizziness in the United States","volume":"31","author":"Ruthberg","year":"2020","journal-title":"VES"},{"key":"2025121603305985000_14.4.e085715.54","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90634-3"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-085715","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:31:12Z","timestamp":1765884672000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-085715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":54,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,2]]},"published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1136\/bmjopen-2024-085715"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-085715","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4]]}}}