Stam et al developed a score which can help to identify an older adult with dizziness who may have an unfavorable outcome. This can identify an older adult who may benefit from more aggressive management.
Patient selection: adult >= 65 years of age with dizziness, excluding severe cognitive impairment, severe psychiatric disease, terminal disease and mutism
Outcome: substantial dizziness-related impairment at 6 months, with Dizziness Handicap Inventory (DHI) >= 30
Parameters:
(1) age of the patient in years
(2) Dizziness Handicap Inventory Screening (DHI-S)
(3) history of cardiac arrhythmia
(4) looking up as provoking factor
|
Parameter
|
Finding
|
LR Factor
|
|
age of the patient
|
|
(age) * 0.056
|
|
DHI-S
|
|
(DHI-S) * 0.115
|
|
cardiac arrhythmia
|
no
|
0
|
|
|
yes
|
0.597
|
|
looking up provokes
|
no
|
0
|
|
|
yes
|
0.523
|
where:
• The adjusted model coefficients used rather than thos in Table 2.
X =
= SUM(LR factors) - 5.687
probability of an unfavorable outcome =
= 1 / (1 + EXP((-1) * X))
Alternatively, a point score may be used:
|
Parameter
|
Finding
|
LR Factor
|
|
age of the patient
|
|
(age)
|
|
DHI-S
|
|
(DHI-S) * 2
|
|
cardiac arrhythmia
|
no
|
0
|
|
|
yes
|
11
|
|
looking up provokes
|
no
|
0
|
|
|
yes
|
11
|
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 65
• maximum score: over 176
• A score >= 134 indicates a high risk for an unfavorable outcome.
