{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:59:20Z","timestamp":1792803560826,"version":"4.5.0"},"reference-count":57,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,10,15]],"date-time":"2013-10-15T00:00:00Z","timestamp":1381795200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2013,10]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n \n Dizziness and vertigo account for about 4 million emergency department (\n ED<\/jats:styled-content>\n ) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in\n ED<\/jats:styled-content>\n patients with vertigo\/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [\n HINTS<\/jats:styled-content>\n ]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [\n ABCD<\/jats:styled-content>\n 2]).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a cross\u2010sectional study of high\u2010risk patients (more than one stroke risk factor) with acute vestibular syndrome (\n AVS<\/jats:styled-content>\n ; acute, persistent vertigo or dizziness with nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness) at a single academic center. All underwent neurootologic examination, neuroimaging (97.4% by magnetic resonance imaging [\n MRI<\/jats:styled-content>\n ]), and follow\u2010up.\n ABCD<\/jats:styled-content>\n 2 risk scores (0\u20137 points), using the recommended cutoff of \u22654 for stroke, were compared to a three\u2010component eye movement battery (\n HINTS<\/jats:styled-content>\n ). Sensitivity, specificity, and positive and negative likelihood ratios (\n LR<\/jats:styled-content>\n +,\n LR<\/jats:styled-content>\n \u2013) were assessed for stroke and other central causes, and the results were stratified by age. False\u2010negative initial neuroimaging was also assessed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 190 adult\n AVS<\/jats:styled-content>\n patients were assessed (1999\u20132012). Median age was 60.5\u00a0years (range\u00a0=\u00a018 to 92\u00a0years; interquartile range [\n IQR<\/jats:styled-content>\n ]\u00a0=\u00a052.0 to 70.0\u00a0years); 60.5% were men. Final diagnoses were vestibular neuritis (34.7%), posterior fossa stroke (59.5% [105 infarctions, eight hemorrhages]), and other central causes (5.8%). Median\n ABCD<\/jats:styled-content>\n 2 was 4.0 (range\u00a0=\u00a02 to 7;\n IQR<\/jats:styled-content>\n \u00a0=\u00a03.0 to 4.0).\n ABCD<\/jats:styled-content>\n 2 \u2265 4 for stroke had sensitivity of 61.1%, specificity of 62.3%,\n LR<\/jats:styled-content>\n + of 1.62, and\n LR<\/jats:styled-content>\n \u2013 of 0.62; sensitivity was lower for those younger than 60\u00a0years old (28.9%).\n HINTS<\/jats:styled-content>\n stroke sensitivity was 96.5%, specificity was 84.4%,\n LR<\/jats:styled-content>\n + was 6.19, and\n LR<\/jats:styled-content>\n \u2013 was 0.04 and did not vary by age. For any central lesion, sensitivity was 96.8%, specificity was 98.5%,\n LR<\/jats:styled-content>\n + was 63.9, and\n LR<\/jats:styled-content>\n \u2013 was 0.03 for\n HINTS<\/jats:styled-content>\n , and sensitivity was 99.2%, specificity was 97.0%,\n LR<\/jats:styled-content>\n + was 32.7, and\n LR<\/jats:styled-content>\n \u2013 was 0.01 for\n HINTS<\/jats:styled-content>\n \u201cplus\u201d (any new hearing loss added to\n HINTS<\/jats:styled-content>\n ). Initial\n MRI<\/jats:styled-content>\n s were falsely negative in 15 of 105 (14.3%) infarctions; all but one was obtained before 48\u00a0hours after onset, and all were confirmed by delayed\n MRI<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n HINTS<\/jats:styled-content>\n substantially outperforms\n ABCD<\/jats:styled-content>\n 2 for stroke diagnosis in\n ED<\/jats:styled-content>\n patients with\n AVS<\/jats:styled-content>\n . It also outperforms\n MRI<\/jats:styled-content>\n obtained within the first 2\u00a0days after symptom onset. While\n HINTS<\/jats:styled-content>\n testing has traditionally been performed by specialists, methods for empowering emergency physicians (\n EP<\/jats:styled-content>\n s) to leverage this approach for stroke screening in dizziness should be investigated.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/acem.12223","type":"journal-article","created":{"date-parts":[[2013,10,15]],"date-time":"2013-10-15T23:16:33Z","timestamp":1381878993000},"page":"986-996","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":357,"title":["HINTS<\/scp>\n Outperforms\n ABCD<\/scp>\n 2 to Screen for Stroke in Acute Continuous Vertigo and Dizziness"],"prefix":"10.1111","volume":"20","author":[{"given":"David E.","family":"Newman\u2010Toker","sequence":"first","affiliation":[{"name":"Johns Hopkins University School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin 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