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Can J Neurol Sci. 2016 May;43(3):398-401. doi: 10.1017/cjn.2015.330. Epub 2016 Jan 20.

The Under-Utilization of the Head Impulse Test in the Emergency Department.

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1
McGill University,Department of Neurology,Montreal,Quebec,Canada.

Abstract

BACKGROUND:

The head impulse test (HIT) is an evidenced based clinical tool to differentiate between peripheral and central causes of vertigo. Our objective was to determine the rate of utilization of the HIT in the emergency room (ER).

METHODS:

A retrospective chart review of patients presenting to the ER over one year who received a final diagnosis of dizziness or vertigo. Details of clinical examinations, investigations, and diagnosis were recorded. Patients were grouped into episodic, acute constant, and chronic vertigo groups.

RESULTS:

HIT was performed in only 31 of 642 (5%) patients with vertigo. In the acute constant group it was negative in 6 of 6 patients ultimately diagnosed with stroke and positive in 6 of 13 cases of peripheral vertigo.

DISCUSSION:

Despite good published evidence regarding its use the HIT is under-utilized in the ER. Physicians need to be aware of the HIT and newer video HITs and make use of them in practice.

KEYWORDS:

neurological examination; stroke; vestibular

PMID:
26787132
DOI:
10.1017/cjn.2015.330
[Indexed for MEDLINE]

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