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  • 2385 Meta-analysis of the head impulse test (HIT) and head impulse test, nystagmus, test of skew (HINT) in the diagnosis of stroke and peripheral vertigo

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2385 Meta-analysis of the head impulse test (HIT) and head impulse test, nystagmus, test of skew (HINT) in the diagnosis of stroke and peripheral vertigo
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  1. Suyi Ooi1,
  2. Grace Phillips2,
  3. Tanya Tang3,
  4. Luke Chen1,4,
  5. Anthony Fok1,
  6. John Ly1,
  7. Henry Ma1,5 and
  8. Thanh Phan1,5
  1. 1Department of Neurology, Monash Health, Clayton, VIC, Australia
  2. 2Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
  3. 3Department of Neurology, Peninsula Health, Frankston, VIC, Australia
  4. 4Department of Neurology, Alfred Health, Melbourne, VIC, Australia
  5. 5Department of Neuroscience Central Clinical School, Monash University, Melbourne, VIC, Australia

Abstract

Objectives We conducted a meta-analysis of the HIT and HINT tests to diagnose peripheral vertigo (PV) and central vertigo in the emergency department (ED).

Methods Pubmed, Google Scholar, EmBase and articles references published in English up to July 2021 were searched for keywords ‘vertigo’ or ‘acute vestibular syndrome’ or ‘dizziness’ and ‘head impulse’ and ‘stroke’. Bivariate method for meta-analysis was used.

Results 11 studies HIT (8 studies, N = 417) and HINT (6 studies, N = 405). HIT and HINT were performed within 24 hours in 4 of 11 studies. Positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for HIT in PV was 4.85 (95% CI 2.83 – 8.08) and 0.19 (95% CI 0.12 – 0.29, I263.25%) respectively. The (area under the curve) AUC for HIT the diagnosis of PV and stroke was 0.90 and 0.92 respectively. PLR and NLR for a negative HIT in stroke was 5.85 (95% CI 3.07 – 10.6) and 0.17 (95% CI 0.08 – 0.30) respectively. PLR and NLR for peripheral HINT pattern for PV was 17.3 (95% CI 8.38 – 32.1) and 0.15 (95% CI 0.07 – 0.26) respectively. PLR and NLR for central HINT pattern for stroke was 5.61 (95% CI 4.19 – 7.7) and 0.06 (95% CI 0.03 – 0.12) respectively.

Conclusion The HIT and HINT exams appear moderately good discriminators of central and peripheral vertigo. However, these results may not apply in the ED setting as most papers evaluated these tests beyond 24 hours.

https://doi.org/10.1136/bmjno-2022-ANZAN.135

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