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Front. Neurol. | doi: 10.3389/fneur.2018.00029

Predictive capability of an iPad based medical device (medx) for the diagnosis of vertigo and dizziness

 Katharina Feil1*, Regina Feuerecker1,  Nicolina Goldschagg1,  Ralf Strobl2,  Thomas Brandt3, Albrecht von Müller4 and  Michael Strupp1
  • 1Neurology and German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Klinikum der Universität München, Germany
  • 2German Center for Vertigo and Balance Disorders and Institute for Medical Information Processing, Biometrics and Epidemiology (IBE), University Hospital, LMU Munich, Klinikum der Universität München, Germany
  • 3German Center for Vertigo and Balance Disorders and Institute for Clinical Neurosciences, University Hospital, LMU Munich, Klinikum der Universität München, Germany
  • 4Parmenides Foundation, Germany

Background:Making the correct diagnosis of patients presenting with vertigo and dizziness in clinical practice is often challenging.
Objective:In this study we analyzed the usage of the iPad based program medx in the prediction of different clinical vertigo and dizziness diagnoses . We examined the power of medx to distinguish between different vertigo diagnoses.
Patients and methods:The data collection was done in the outpatient clinic of the German Center of Vertigo and Balance Disorders. The “gold standard diagnosis” was defined as the clinical diagnosis of the specialist during the visit of the patient standardized history and clinical examination. Another independent and blinded physician finalized each patient’s case in constellatory diagnostic of medx by entering all available clinical information in the system. The accuracy, sensitivity, specificity as well as positive and negative predictive values for the most common diagnoses were determined. Sixteen possible different vertigo and dizziness diagnoses could be provided by medx constellatory diagnostic system. These diagnoses were compared to the “gold standard” by retrospective review of the charts of the patients over the study period.
Results:610 patients (mean age58.1±16.3 years, 51.2% female) were included. The accuracy for the most common diagnoses was between 82.1- 96.6% with a sensitivity from 40- 80.5% and a specificity of more than 80%. When analyzing the quality of medx in a multiclass-problem for the six most common clinical diagnoses the sensitivity, specificity, positive and negative predictive value were as follows: Bilateral vestibulopathy (81.6%, 97.1%, 71.1%, 97.5%), Menière's disease (77.8%, 97.6%, 87.%, 95.3%), benign paroxysmal positional vertigo (61.7%, 98.3%, 86.6%, 93.4%), downbeat nystagmus syndrome (69.6%, 97.7%, 71.1%, 97.5%), vestibular migraine (34.7%, 97.8%, 76.1%, 88.3%) and phobic postural vertigo (80.5%, 82,5%, 52.5%, 94.6%),
Conclusions:This study demonstrates that medx is a new and easy approach to screen for different diagnoses. With the high specificity and high negative predictive value the system helps to rule out differential diagnoses and can therefore also lead to a cost reduction in health care system. However, the sensitivity was unexpectedly low, especially for vestibular migraine. All in all, this device can only be a complementary tool, in particular for non-experts in the field.

Keywords: vestibular, diagnosis, ipad, Dizziness, Vertigo, medical devices

Received: 08 Nov 2017; Accepted: 15 Jan 2018.

Edited by:

Raymond Van De Berg, Maastricht University Medical Centre, Netherlands

Reviewed by:

Bernard Cohen, Icahn School of Medicine at Mount Sinai, United States
Nicolas Perez-Fernandez, Universidad de Navarra, Spain  

Copyright: © 2018 Feil, Feuerecker, Goldschagg, Strobl, Brandt, von Müller and Strupp. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Katharina Feil, Klinikum der Universität München, Neurology and German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistraße 15, Munich, 81377, Bavaria, Germany,