Alexandra E Quimby1, Edmund S H Kwok2, Daniel Lelli3, Peter Johns2, Darren Tse4. 1. Department of Otolaryngology- Head and Neck Surgery, University of Ottawa, S3, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. Aquim047@uottawa.ca. 2. Department of Emergency Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. 3. Department of Medicine, Division of Neurology, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada. 4. Department of Otolaryngology- Head and Neck Surgery, University of Ottawa, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
Abstract
BACKGROUND: Dizziness is a common presenting symptom in the emergency department (ED). The HINTS exam, a battery of bedside clinical tests, has been shown to have greater sensitivity than neuroimaging in ruling out stroke in patients presenting with acute vertigo. The present study sought to assess practice patterns in the assessment of patients in the ED with peripherally-originating vertigo with respect to utilization of HINTS and neuroimaging. METHODS: A retrospective cohort study was performed using data pertaining to 500 randomly selected ED visits at a tertiary care centre with a final diagnostic code related to peripherally-originating vertigo between January 1, 2010 - December 31, 2014. RESULTS: A total of 380 patients met inclusion criteria. Of patients presenting to the ED with dizziness and vertigo and a final diagnosis of non-central vertigo, 139 (36.6%) received neuroimaging in the form of CT, CT angiography, or MRI. Of patients who did not undergo neuroimaging, 17 (7.1%) had a bedside HINTS exam performed. Almost half (44%) of documented HINTS interpretations consisted of the ambiguous usage of "HINTS negative" as opposed to the terminology suggested in the literature ("HINTS central" or "HINTS peripheral"). CONCLUSIONS: In this single-centre retrospective review, we have demonstrated that the HINTS exam is under-utilized in the ED as compared to neuroimaging in the assessment of patients with peripheral vertigo. This finding suggests that there is room for improvement in ED physicians' application and interpretation of the HINTS exam.
BACKGROUND:Dizziness is a common presenting symptom in the emergency department (ED). The HINTS exam, a battery of bedside clinical tests, has been shown to have greater sensitivity than neuroimaging in ruling out stroke in patients presenting with acute vertigo. The present study sought to assess practice patterns in the assessment of patients in the ED with peripherally-originating vertigo with respect to utilization of HINTS and neuroimaging. METHODS: A retrospective cohort study was performed using data pertaining to 500 randomly selected ED visits at a tertiary care centre with a final diagnostic code related to peripherally-originating vertigo between January 1, 2010 - December 31, 2014. RESULTS: A total of 380 patients met inclusion criteria. Of patients presenting to the ED with dizziness and vertigo and a final diagnosis of non-central vertigo, 139 (36.6%) received neuroimaging in the form of CT, CT angiography, or MRI. Of patients who did not undergo neuroimaging, 17 (7.1%) had a bedside HINTS exam performed. Almost half (44%) of documented HINTS interpretations consisted of the ambiguous usage of "HINTS negative" as opposed to the terminology suggested in the literature ("HINTS central" or "HINTS peripheral"). CONCLUSIONS: In this single-centre retrospective review, we have demonstrated that the HINTS exam is under-utilized in the ED as compared to neuroimaging in the assessment of patients with peripheral vertigo. This finding suggests that there is room for improvement in ED physicians' application and interpretation of the HINTS exam.
Entities:
Keywords:
Dizziness; HINTS; Head impulse; Neuroimaging; Vertigo
Authors: David E Newman-Toker; Yu-Hsiang Hsieh; Carlos A Camargo; Andrea J Pelletier; Gregary T Butchy; Jonathan A Edlow Journal: Mayo Clin Proc Date: 2008-07 Impact factor: 7.616
Authors: Alexander A Tarnutzer; Aaron L Berkowitz; Karen A Robinson; Yu-Hsiang Hsieh; David E Newman-Toker Journal: CMAJ Date: 2011-05-16 Impact factor: 8.262
Authors: David E Newman-Toker; Kevin A Kerber; Yu-Hsiang Hsieh; John H Pula; Rodney Omron; Ali S Saber Tehrani; Georgios Mantokoudis; Daniel F Hanley; David S Zee; Jorge C Kattah Journal: Acad Emerg Med Date: 2013-10 Impact factor: 3.451
Authors: Kailash Krishnan; Kerolos Bassilious; Erik Eriksen; Philip M Bath; Nikola Sprigg; Sigrun Kierulf Brækken; Hege Ihle-Hansen; Morten Andreas Horn; Else Charlotte Sandset Journal: Eur Stroke J Date: 2019-04-10
Authors: Athanasia Korda; Wilhelm Wimmer; Ewa Zamaro; Franca Wagner; Thomas C Sauter; Marco D Caversaccio; Georgios Mantokoudis Journal: Front Neurol Date: 2022-07-12 Impact factor: 4.086