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HINTS Bedside Exam: Efficacy in Improving Detection of Stroke in Patients Presenting to the ED for Dizziness

8 August 2015


Background: Worldwide, stroke is the second most common cause of mortality and third most common cause of disability. There are certain areas within the brain, that when affected by ischemia, do not present the way most providers are used to. Strokes in the posterior fossa area can present with a combination of symptoms known as acute vestibular syndrome (AVS). The HINTS exam is a bedside assessment which looks at oculomotor findings to detect stroke located in these areas. The HINTS exam has been shown to have a higher sensitivity and specificity than early imaging. However, this is not an exam that is being widely used throughout emergency departments (ED). Can the HINTS bedside exam improve detection of stroke in those patients presenting with AVS?

Methods: An exhaustive search was conducted using Medline-OVID, CINAHL and Web of Science using the keywords: HINTS and stroke. Relevant articles were assessed for quality using GRADE. A search on the NIH clinical trials site reveals there are no trials currently registered relating to the use of the HINTS exam for diagnosing stroke.

Results:A total of four articles were included in this systematic review. Three of these met the inclusion criteria while the fourth was included due to the relationship to the others. These were all prospective, cross-sectional studies. The first enrolled 101 subjects and showed the HINTS bedside exam had a higher sensitivity and specificity than other general neurologic signs and initial MRI. The second study, with 190 enrolled participants, showed that the HINTS exam was superior to another stroke detection method (ABCD2) and early MRI as well. The third article, 190 enrolled participants, looked at the HINTS and HINTS “plus” exam in identifying small,

Conclusion: The HINTS beside exam has been demonstrated to be an effective method in detecting stroke in those patients presenting with AVS to the emergency department. This is especially true in those with known stroke risk factors. There is a need for further research to demonstrate the same results in a larger sample size and to see whether the results are consistent when emergency department providers administer the tests instead of specialists.

Keywords: HINTS, stroke


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