Is the HINTS Exam Accurate? A Systematic Review

October 7, 2024

Written by Jason Lesnick

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This systematic review snapshot found that when the HINTS exam is used by properly trained clinicians, it shows high sensitivity and moderate specificity to identify central causes of acute vestibular syndrome (AVS).

How good are HINTS and HINTS+?
This paper is a clinical synopsis of this systematic review and provides us with data on how well the HINTS, HINTS+, and the components of these exams perform in this scenario.

The meta-analysis examined 16 studies, 14 of which were prospective and included 2,024 patients, of whom 28.1% had a central cause of AVS. 7/16 of the studies had neurologists perform the HINTS exam, 3/16 neuro-otologists, and 2/16 were by EM physicians. 12/16 studies evaluated the HINTS exam, 5 the HINTS+, 3 the HINTS with video assistance, and 2 the HINTS+ with video assistance. 2/16 studies were set in the ED and 13/16 studies considered the standard for comparison to be MRI.

Both the HINTS and HINTS+ exams demonstrated high sensitivity as seen in the table below. A positive test of skew or vertical or direction changing nystagmus were highly specific for a central etiology.

This meta-analysis had a wide range of sensitivity and specificity of the HINTS exams – one study found a sensitivity of only 35% and another 80%. The studies had different inclusion and exclusion criteria and may have included patients without true AVS.

How will this change my practice?
This study will not change my practice. Similar to the GRACE-3 guidelines, this is full of interesting data that reaffirms the potential utility of the HINTS exam. I agree with the authors that we need additional research comparing the HINTS exams to MRI in the ED.

Source
Are the HINTS and HINTS Plus Examinations Accurate for Identifying a Central Cause of Acute Vestibular Syndrome? Ann Emerg Med. 2024 Jul;84(1):60-62. doi: 10.1016/j.annemergmed.2024.01.027. Epub 2024 Feb 22. PMID: 38385911.