Epidemiología de los trastornos del equilibrio en atención primaria / Epidemiology of balance disorders in primary care

ANTECEDENTES Y OBJETIVO: Actualmente, no existen series de pacientes que hayan descrito la incidencia de cada una de las enfermedades que causan alteraciones del equilibrio (AE) en atención primaria. El objetivo de este estudio es calcular la incidencia de cada una de ellas para proponer medidas formativas específicas. MATERIALES Y MÉTODO: Estudio transversal prospectivo. Se obtuvieron los datos de los pacientes de cinco cupos de médicos en cinco centros diferentes de atención primaria de nuestra área hospitalaria. Durante un año se reclutaron todos los pacientes que acudieron a consultas por cualquier tipo de vértigo, inestabilidad o mareo como motivo principal de consulta. Mediante un algoritmo diagnóstico-terapéutico los pacientes fueron diagnosticados y tratados en atención primaria o derivados para su estudio en atención hospitalaria. RESULTADOS: La población estudiada fue de 7.896 personas. Se detectó una incidencia anual de AE del 2,2%. El 56,1% de los casos pudo ser diagnosticado y tratado en atención primaria. El 53,8% de los pacientes fue diagnosticado de algún tipo de vértigo posicional. Los siguientes tres diagnósticos más frecuentes fueron migraña vestibular, isquemia del sistema nervioso central y efectos secundarios de medicamentos. Estos cuatro grupos sumaron un 87,9% de la población. CONCLUSIONES: La incidencia de las AE en atención primaria requiere un abordaje en el que se incluya formación en el diagnóstico y tratamiento del vértigo posicional paroxístico benigno, la cefalea, los factores de riesgo cardiovascular y de farmacología, no siendo necesario prescribir sedantes vestibulares en la mayoría de los casos

BACKGROUND AND OBJECTIVE: In our country, there are no series of patients that have described the incidence of the different diseases which cause balance disorders (BD) in primary care. The objective of this study is to calculate the incidence of each disease to propose specific training measures. MATERIALS AND METHOD: Prospective cross-sectional study. Patient data of five primary care physicians in five different primary care centres in our hospital area were collected. All patients who attended consultations for any type of vertigo, imbalance or dizziness over one year as the main reason for consultation were recruited. Using a diagnostic-therapeutic algorithm, patients were diagnosed and treated in primary care or referred for study in hospital care. RESULTS: The population studied was 7,896 people. An annual incidence of BD of 2.2% was detected. Of the cases, 56.1% could be diagnosed and treated in primary care. Of the patients, 53.8% were diagnosed with some type of positional vertigo; the next three most frequent diagnoses were vestibular migraine, central nervous system ischaemia and medication side effects. These four groups accounted for 87.9% of the population. CONCLUSIONS: The incidence of BD in primary care requires an approach that includes training in the diagnosis and treatment of benign paroxysmal positional vertigo, headache, cardiovascular risk factors and pharmacology. It is not necessary to prescribe vestibular suppressants in most patients

Epidemiology of balance disorders in primary care. / Epidemiología de los trastornos del equilibrio en atención primaria.

BACKGROUND AND OBJECTIVE: In our country, there are no series of patients that have described the incidence of the different diseases which cause balance disorders (BD) in primary care. The objective of this study is to calculate the incidence of each disease to propose specific training measures. MATERIALS AND METHOD: Prospective cross-sectional study. Patient data of five primary care physicians in five different primary care centres in our hospital area were collected. All patients who attended consultations for any type of vertigo, imbalance or dizziness over one year as the main reason for consultation were recruited. Using a diagnostic-therapeutic algorithm, patients were diagnosed and treated in primary care or referred for study in hospital care. RESULTS: The population studied was 7,896 people. An annual incidence of BD of 2.2% was detected. Of the cases, 56.1% could be diagnosed and treated in primary care. Of the patients, 53.8% were diagnosed with some type of positional vertigo; the next three most frequent diagnoses were vestibular migraine, central nervous system ischaemia and medication side effects. These four groups accounted for 87.9% of the population. CONCLUSIONS: The incidence of BD in primary care requires an approach that includes training in the diagnosis and treatment of benign paroxysmal positional vertigo, headache, cardiovascular risk factors and pharmacology. It is not necessary to prescribe vestibular suppressants in most patients.

Balance disorders as potential confounders associated with an increased risk of acute cerebrovascular accidents.

PURPOSE: There is a higher risk of stroke after suffering from balance disorders (BDs) such as vertigo or dizziness. The causal relationship remains unclear due to the limited scope of the existing studies and the high prevalence of cardiovascular risk factors (CVRFs) in BD patients. The objective of this study is to clarify the role that BDs seem to have in the development of acute cerebrovascular accidents (ACAs). METHODS: This is an observational prospective study. The CVRFs and demographic factors of a sample of our population were noted. Five clusters of patients were tracked over the course of 2 years to detect and diagnose BDs and ACAs. The causal relationships between the CVRFs, BDs and ACAs were analyzed in a univariate analysis. A logistic regression multivariant analysis was performed on those variables that reached statistical significance. RESULTS: The sample included 7886 participants and 31 ACAs were recorded. CVRFs that reached statistical significance included age ≥ 60, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, atrial fibrillation and previous ACAs. The relationship between BDs and ACAs always reached statistical significance, regardless of how the BD variable was defined. Five different multivariate analyses were performed, but in none of them did the BD variables significantly reduce the deviance and thus, they were not taken into account when building the final model. CONCLUSION: This study shows that BDs are probably confounders that are closely linked to other CVRFs and they are also useful red flags to identify patients at a higher risk of suffering from ACAs.