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Updated: Mar 26, 2026
Testing of all Six Semicircular Canals with Video Head Impulse Test Systems
Published on: April 18, 2019
The Under-Utilization of the Head Impulse Test in the Emergency Department
Timothy McDowell1, Fraser Moore1
1McGill University,Department of Neurology,Montreal,Quebec,Canada.
Background:
The head impulse test (HIT) is an evidenced based clinical tool to differentiate between peripheral and central causes of vertigo. Our objective was to determine the rate of utilization of the HIT in the emergency room (ER).
Methods:
A retrospective chart review of patients presenting to the ER over one year who received a final diagnosis of dizziness or vertigo. Details of clinical examinations, investigations, and diagnosis were recorded. Patients were grouped into episodic, acute constant, and chronic vertigo groups.
Results:
HIT was performed in only 31 of 642 (5%) patients with vertigo. In the acute constant group it was negative in 6 of 6 patients ultimately diagnosed with stroke and positive in 6 of 13 cases of peripheral vertigo.
Discussion:
Despite good published evidence regarding its use the HIT is under-utilized in the ER. Physicians need to be aware of the HIT and newer video HITs and make use of them in practice.
