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We conducted a systematic review and meta\u2010analysis of the diagnostic test accuracy of physical examination findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study involved a patient\u2013intervention\u2013control\u2013outcome (PICO) question: (P) adult ED patients with vertigo\/dizziness; (I) presence\/absence of specific physical examination findings; and (O) central (ischemic stroke, hemorrhage, others) versus peripheral etiology. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 6309 titles, 460 articles were retrieved, and 43 met the inclusion criteria: general neurologic examination\u2014five studies, 869 patients, pooled sensitivity 46.8% (95% confidence interval [CI] 32.3%\u201361.9%, moderate certainty) and specificity 92.8% (95% CI 75.7%\u201398.1%, low certainty); limb weakness\/hemiparesis\u2014four studies, 893 patients, sensitivity 11.4% (95% CI 5.1%\u201323.6%, high) and specificity 98.5% (95% CI 97.1%\u201399.2%, high); truncal\/gait ataxia\u201410 studies, 1810 patients (increasing severity of truncal ataxia had an increasing sensitivity for central etiology, sensitivity 69.7% [43.3%\u201387.9%, low] and specificity 83.7% [95% CI 52.1%\u201396.0%, low]); dysmetria signs\u2014four studies, 1135 patients, sensitivity 24.6% (95% CI 15.6%\u201336.5%, high) and specificity 97.8% (94.4%\u201399.2%, high); head impulse test (HIT)\u201417 studies, 1366 patients, sensitivity 76.8% (64.4%\u201385.8%, low) and specificity 89.1% (95% CI 75.8%\u201395.6%, moderate); spontaneous nystagmus\u2014six studies, 621 patients, sensitivity 52.3% (29.8%\u201374.0%, moderate) and specificity 42.0% (95% CI 15.5%\u201374.1%, moderate); nystagmus type\u201416 studies, 1366 patients (bidirectional, vertical, direction changing, or pure torsional nystagmus are consistent with a central cause of vertigo, sensitivity 50.7% [95% CI 41.1%\u201360.2%, moderate] and specificity 98.5% [95% CI 91.7%\u201399.7%, moderate]); test of skew\u201415 studies, 1150 patients (skew deviation is abnormal and consistent with central etiology, sensitivity was 23.7% [95% CI 15%\u201335.4%, moderate] and specificity 97.6% [95% CI 96%\u201398.6%, moderate]); HINTS (head impulse, nystagmus, test of skew)\u201414 studies, 1781 patients, sensitivity 92.9% (95% CI 79.1%\u201397.9%, high) and specificity 83.4% (95% CI 69.6%\u201391.7%, moderate); and HINTS+ (HINTS with hearing component)\u2014five studies, 342 patients, sensitivity 99.0% (95% CI 73.6%\u2013100%, high) and specificity 84.8% (95% CI 70.1%\u201393.0%, high).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most neurologic examination findings have low sensitivity and high specificity for a central cause in patients with acute vertigo or dizziness. In acute vestibular syndrome (monophasic, continuous, persistent dizziness), HINTS and HINTS+ have high sensitivity when performed by trained clinicians.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14630","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T12:41:14Z","timestamp":1669898474000},"page":"552-578","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta\u2010analysis for <scp>GRACE<\/scp>\u20103"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7871-7066","authenticated-orcid":false,"given":"Vishal Paresh","family":"Shah","sequence":"first","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5388-9163","authenticated-orcid":false,"given":"Lucas","family":"Oliveira J. e Silva","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Emergency Medicine Hospital de Cl\u00ednicas de Porto Alegre  Porto Alegre Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wigdan","family":"Farah","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed O.","family":"Seisa","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdalla Kara","family":"Balla","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5183-2400","authenticated-orcid":false,"given":"April","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Community Internal Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdoleen","family":"Farah","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashar","family":"Hasan","sequence":"additional","affiliation":[{"name":"Evidence\u2010Based Practice Center Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1632-4750","authenticated-orcid":false,"given":"Fernanda","family":"Bellolio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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