Abstract Body

Abstract

Background and purpose:

Dizziness is a common and challenging clinical presentation in general practice. A GPs approach is important in reducing misdiagnosis and ensuring appropriate resource allocation. We aimed to establish frequency and associations of GP trainees’ (registrars’) specific vertigo provisional diagnoses and their non-specific symptomatic problem formulations.

Method:

A cross-sectional analysis of Registrar Clinical Encounters in Training (ReCEnT) cohort study data, 2010-2018. The outcome factor was whether dizziness- or vertigo-related presentations resulted in a specific vertigo or a non-specific symptomatic problem formulation. Associations with patient, practice, registrar, and consultation independent variables were assessed by univariate and multivariable logistic regression.

Results:

2,333 registrars recorded 1,734 (0.34%) new problems related to dizziness or vertigo. Of these, 546 (31.5%) involved a specific vertigo diagnosis and 1,188 (68.5%) a non-specific symptom diagnosis. Variables associated with a non-specific symptom diagnosis on multivariable analysis were longer consultation duration (OR 1.02, 95% CIs 1.00,1.04), and pathology (8.25 [95% CI: 4.94,13.8]) and imaging (4.09 [95% CI: 2.26,7.41]) being ordered. A specific vertigo diagnosis was associated with performing a procedure (OR 0.52, 95% CIs 0.27,1.00), prescribing medicine (0.32 [95% CI: 0.24,0.43]) and with some evidence for seeking information from a non-supervisor source (OR 1.39, 95% CIs 0.92,2.09; p=0.12).

Conclusion:

The frequency and associations of a non-specific diagnosis are consistent with the acknowledged difficulty of making diagnoses in these presentations. Registrars are appropriately calling on their supervisors for diagnostic purposes. Continuing emphasis on this area in GP training and encouragement of supervisor involvement in registrars’ diagnostic processes is indicated.