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Vol. 72. Issue 1.
Pages 11-20 (January - February 2021)
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Vol. 72. Issue 1.
Pages 11-20 (January - February 2021)
Original article
Epidemiology of Balance Disorders in Primary Care
Epidemiología de los trastornos del equilibrio en atención primaria
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Emilio Domínguez-Durána,
Corresponding author
, Irene Mármol-Szombathya, Estela Palmero-Olmob, Ana Nogales-Nievesc, María José López-Urbanod, Ana Palomo-Sáncheze, Fátima Alarcón-Balanzaf, María Ruiz-de Arcosg, Beatriz Bullón-Fernándezf, Feliciana Valle-Martíne, Antonio Mora-Quinterod, Blas Poyatos-Poyatosc, María Teresa Manjón-Colladob, Serafín Sánchez-Gómeza
a Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Centro de Salud «El Mirador», San José de la Rinconada, Sevilla, Spain
c Centro de Salud «Polígono Norte», Sevilla, Spain
d Centro de Salud «Ronda Histórica», Sevilla, Spain
e Centro de Salud «Alamillo», Sevilla, Spain
f Centro de Salud «Pino Montano A», Sevilla, Spain
g Unidad de Gestión Clínica de Neurología y Neurofisiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Tables (3)
Table 1. Diagnoses Categories Used by the Diagnostic-therapeutic Algorithms for Patient Management. To Facilitate Association With the International Classification of Vestibular Disorders (ICVD)9 Layers I (Signs and Symptoms) and II (Syndromes) Were Added to Those Belonging to Each Diagnostic Group.
Table 2. Number of Cases Present in Each Diagnosis and Its Percentage Over the Total Number of Patients. Note That the Sum of the Percentages Is Higher Than 100%, Which Is Due to the Fact That More Than One Diagnosis Was Made in Some Patients.
Table 3. Summary of Side Effects to Drugs Present in the Population.
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Abstract
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 were recruited as well as the main reason for consultation. 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 7896 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.

Keywords:
Primary care
Benign paroxysmal positional vertigo
Vestibular migraine
Vascular brain injuries
Cerebral small vessel diseases
Drug-Related side effects and adverse reactions
Resumen
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 a 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 7896 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.

Palabras clave:
Atención primaria
Vértigo posicional paroxismal benigno
Migraña vestibular
Lesiones cerebrales vasculares
Enfermedad cerebral de pequeños vasos
Enfermedad de pequeños vasos
Efectos colaterales y reacciones adversas relacionados con fármacos

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