Age-dependent Sensitivity and Specificity of ABCD2 and HINTS-plus for Acute Vertigo Diagnosis
Nehzat Koohi1, Benjamin Sacks2, Maria Francisca Rocha2, Alexander Heatley3, Salman Haider2, Arvind Chandratheva2, Robert Simister2, Diego Kaski2
1University College London Hospitals NHS Foundation Trust, London, UK, 2National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, 3Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London
Objective:
This study aims to compare the diagnostic accuracy of emergency department (ED) clinicians with that of acute vertigo (AV) specialists in patients with acute vertigo. It seeks to evaluate the effectiveness of clinical predictors including the HINTS-plus examination and ABCD2 scores in diagnosing stroke among AV patients in emergency settings.
Background:
Acute vertigo is common, accounting for approximately 4% of global ED visits. Differentiating between benign peripheral vestibular dysfunction and serious central pathologies such as stroke poses a significant clinical challenge. Existing diagnostic tools like HINTS-plus and STANDING algorithms have high sensitivity and specificity but are often underutilised due to limited clinician training and over-reliance on brain imaging.
Design/Methods:
A prospective cohort study was conducted on 70 adult patients referred to an acute vertigo clinic at the National Hospital for Neurology and Neurosurgery, UK. Data on patient demographics, clinical presentations, diagnostic assessments, and outcomes were collected from both ED and specialist evaluations. Statistical analyses, including logistic regression and ROC curve analysis, were performed to assess the diagnostic predictors.
Results:
Significant diagnostic inconsistencies were found, with only 23% of ED diagnoses matching those of acute vertigo specialists. Common diagnoses in the ED included unspecified cause of vertigo, benign paroxysmal positional vertigo (BPPV), and peripheral vestibular dysfunction (PVD), while specialists frequently identified vestibular migraine and acute vascular causes. The HINTS-plus exam and the presence of neurological signs were strong predictors of stroke, particularly in younger patients.
Conclusions:
Our study demonstrates significant diagnostic discrepancies between ED clinicians and acute vertigo specialists, emphasising the need for improved training and the implementation of advanced diagnostic protocols in the ED. Detailed clinical assessments, such as the HINTS-plus exam and ABCD2 score, are critical for accurate diagnosis, particularly in younger patients. Addressing these gaps is crucial for optimising care and reducing the economic burden of AV misdiagnoses in emergency settings.
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