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However, their application may be limited by lack of training and absence of vertigo\/nystagmus. Alternatively, a graded gait\/truncal-instability (GTI, grade 0\u20133) rating may be applied.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a systematic search (MEDLINE\/Embase) to identify studies reporting on the diagnostic accuracy of bedside examinations in adults with acute vestibular syndrome. Diagnostic test properties were calculated for findings using a random-effects model. Results were stratified by GTI-rating used.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We identified 6515 articles and included 18 studies (<jats:italic>n<\/jats:italic>\u2009=\u20091025 patients). Ischemic strokes (<jats:italic>n<\/jats:italic>\u2009=\u2009665) and acute unilateral vestibulopathy (<jats:italic>n<\/jats:italic>\u2009=\u2009306) were most frequent. Grade 2\/3 GTI had moderate sensitivity (70.8% [95% confidence-interval (CI)\u2009=\u200959.3\u201382.3%]) and specificity (82.7 [71.6\u201393.8%]) for predicting a central cause, whereas grade 3 GTI had a lower sensitivity (44.0% [34.3\u201353.7%] and higher specificity (99.1% [98.0\u2013100.0%]). In comparison, diagnostic accuracy of HINTS (sensitivity\u2009=\u200996.8% [94.8\u201398.8%]; specificity\u2009=\u200997.6% [95.3\u201399.9%]) was higher. When combining central nystagmus-patterns and grade 2\/3 GTI, sensitivity was increased to 76.4% [71.3\u201381.6%] and specificity to 90.3% [84.3\u201396.3%], however, no random effects model could be used. Sensitivity was higher in studies using the GTI rating (grade 2\/3) by Lee (2006) compared to the approach by Moon (2009) (73.8% [69.0\u201378.0%] vs. 57.4% [49.5\u201364.9%], <jats:italic>p<\/jats:italic>\u2009=\u20090.001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In comparison to HINTS, the diagnostic accuracy of GTI is inferior. When combined with central nystagmus-patterns, diagnostic accuracy could be improved based on preliminary findings. GTI can be readily applied in the ED-setting and also in patients with acute imbalance syndrome.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12311-024-01718-6","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T09:01:48Z","timestamp":1720688508000},"page":"2244-2256","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Systematic Review and Meta-Analysis of the Diagnostic Accuracy of a Graded Gait and Truncal Instability Rating in Acutely Dizzy and Ataxic Patients"],"prefix":"10.1007","volume":"23","author":[{"given":"Carlos","family":"Martinez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Zalazar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Carmona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Kattah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Andrea","family":"Tarnutzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"1718_CR1","doi-asserted-by":"publisher","first-page":"765","DOI":"10.4065\/83.7.765","volume":"83","author":"DE Newman-Toker","year":"2008","unstructured":"Newman-Toker DE, Hsieh YH, Camargo CA Jr, Pelletier AJ, Butchy GT, Edlow JA. 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