Patterns of presentations of dizziness in primary care-a cross-sectional cluster analysis study
Nazareth I., Landau S., Yardley L., Luxon L.
Objectives: Dizziness is a common symptom in adults in primary care. We explored in a sample of people recruited from general practice the existence of patterns of presentations, their characteristics, and clinical and health service predictors. Method: We assessed in a cross-sectional random sample of people registered at London general practices in the United Kingdom the following: subtypes of dizziness, effect on personal activity and physical function, relevant medical and drug history, level of anxiety or depression, treatments received, and information on whether help was sought from their general practitioners. Results: Of 1820 subjects, 442 (24.3%) reported symptoms of dizziness. We identified three clinical presentations. Group 1 was a "nonspecific" presentation experienced by 113 (25.5%) people and characterized by true vertigo, presyncope, disequilibrium, and other types of dizziness with severe impact on all aspects of function. The other two groups were characterized by true vertigo and presyncope. In Group 2 [193 (43.7%)], these symptoms had some impact on personal and daily function, whereas in Group 3 [136 (30.7%)], there was no impact. Eighty-four percent of the people in Group 1 consulted their family practitioner on account of their symptoms, 61% did so in Group 2, and only 38% in Group 3. On multinomial logistic regression analysis, current depression, unemployment, and use of prescribed medication were predictors of the Group 1 compared with Group 2, whereas increasing anxiety and depression scores on the Hospital Anxiety and Depression Scale were predictors of the Group 2 compared with the Group 3. Conclusions: This is the first step in classifying dizziness from a symptomatic and functional point of view. Further research is required on the natural progression of these presentations and their relationship to each other. © 2006 Elsevier Inc. All rights reserved.