HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness

Area of Science:

• Neurology
• Emergency Medicine
• Ophthalmology

Background:

• Dizziness and vertigo are common emergency department complaints, with a significant proportion caused by cerebrovascular events.
• Accurate stroke diagnosis in patients with acute vestibular syndrome (AVS) is challenging due to the frequent absence of focal neurological signs on initial presentation.

Purpose of the Study:

• To compare the diagnostic accuracy of the Head Impulse, Nystagmus Type, Test of Skew (HINTS) examination versus the ABCD2 score for bedside stroke screening in patients presenting with dizziness.

Main Methods:

• A cross-sectional study involving 190 high-risk AVS patients who underwent neurootologic examination and neuroimaging (primarily MRI).
• Comparison of HINTS examination findings and ABCD2 risk scores (cutoff ≥4) for stroke detection.
• Assessment of sensitivity, specificity, and likelihood ratios, stratified by age, and evaluation of false-negative initial neuroimaging.

Main Results:

• HINTS demonstrated superior accuracy for stroke detection (sensitivity 96.5%, specificity 84.4%) compared to ABCD2 (sensitivity 61.1%, specificity 62.3%).
• HINTS accuracy remained consistent across age groups, whereas ABCD2 sensitivity decreased in patients younger than 60.
• HINTS also outperformed MRI within the first 48 hours of symptom onset, with a lower rate of false negatives.

Conclusions:

• The HINTS examination is a significantly more accurate tool than the ABCD2 score for identifying stroke in ED patients with AVS.
• HINTS also shows higher accuracy than early MRI, suggesting its utility in the initial diagnostic workup.
• Further investigation is warranted to enable emergency physicians to effectively utilize HINTS for stroke screening in dizziness presentations.