Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 10;47(1):54.
doi: 10.1186/s40463-018-0305-8.

Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department

Alexandra E Quimby  1 , Edmund S H Kwok  2 , Daniel Lelli  3 , Peter Johns  2 , Darren Tse  4
Affiliations

Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department

Alexandra E Quimby et al. J Otolaryngol Head Neck Surg. .

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.

Keywords: Dizziness; HINTS; Head impulse; Neuroimaging; Vertigo.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Our study was approved by our local REB.

Consent for publication

Not applicable.

Competing interests

The authors declares that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the use of HINTS and neuroimaging in assessment of patients presenting to ED with dizziness/ vertigo, 2010–2014
Fig. 2
Fig. 2
Relative proportions of patients receiving neuroimaging, HINTS exams, and other bedside tests of vertigo
Fig. 3
Fig. 3
Number of HINTS exams performed by year, 2010–2014
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Newman-Toker DE, Hsieh YH, Camargo CA, Jr, et al. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83:765–775. doi: 10.4065/83.7.765. - DOI - PMC - PubMed
    1. Kerber KA, Meurer WJ, West BT, Fendrick M. Dizziness presentations in U.S. emergency departments, 1995-2004. Aca Emerg Med. 2008;15(8):744–750. doi: 10.1111/j.1553-2712.2008.00189.x. - DOI - PubMed
    1. Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke. 2006;37:2484–2487. doi: 10.1161/01.STR.0000240329.48263.0d. - DOI - PMC - PubMed
    1. Schneiderman N, Bies C, Chan SB, Garcia C. Vertigo, ataxia, and strokes: an emergency department study. Ann Emerg Med. 2015;66(4):S84. doi: 10.1016/j.annemergmed.2015.07.263. - DOI
    1. Ozono Y, Kitahara T, Fukushima M, Michiba T, Imai R, et al. Differential diagnosis of vertigo and dizziness in the emergency department. Acta Otolaryngol. 2014;134:140–145. doi: 10.3109/00016489.2013.832377. - DOI - PubMed