Table 2.
Results of the 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: 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).