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November 2, 1994

Does This Dizzy Patient Have a Serious Form of Vertigo? Comment and Correction-Reply

Author Affiliations

Mayo Clinic Rochester, Minn

JAMA. 1994;272(17):1324. doi:10.1001/jama.1994.03520170033019

In Reply.  —We appreciate the comments by Dr Warr regarding the study by Herr et al.1 In reviewing the published literature on dizziness, we found only a few articles that addressed the accuracy of the history and physical examination in categorizing the various causes of dizziness and many of these had limitations.The sensitivity and specificity of the history and physical examination findings in the evaluation of a patient with dizziness and vertigo depend on the physician's knowledge, experience, and skill. The positive and negative predictive value of the history and physical examination also depends on the prevalence of disease in the medical setting in which the patients are evaluated. In Table 3 of the article, we reported that the negative predictive value of a cluster of specific history and examination findings was 88% for serious causes of dizziness.Dr Warr's comments about the comfort threshold and decision making

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