scholarly journals HINTS protocole and it’s accuracy to identify posterior circulation stroke: a review

2021 ◽  
Author(s):  
Eduardo Sales Loureiro ◽  
Luna Vasconcelos Felippe ◽  
Ana Luiza Cotta Mourão Guimarães ◽  
Anna Carolina Dockhorn de Menezes Carvalho Costa
Keyword(s):  
Hearing Loss ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Emergency Departments ◽  
Posterior Circulation ◽  
Clinical Use ◽  
Emergency Physicians ◽  
Practical Application ◽  
Posterior Circulation Stroke ◽  
Acute Vestibular Syndrome

Introduction: The HINTS protocol is important to differentiate peripheral from central vertigo in Acute Vestibular Syndrome (AVS). There are studies that show almost 1/3 of patients have posterior circulation stroke. It is important to investigate why this happens. Objectives: Review the accuracy of HINTS test in the diagnosis of posterior circulation stroke. Methods: Review conducted in PubMed using key words “HINTS AND ACCURACY AND STROKE”. The search found 9 articles, 7 of which were included. Results: Tehrani et al. (2014) studied HINTS’s accuracy when associated with hearing loss, resulting on a bigger accuracy than MRI. Newman- Toker et al. (2013) found that HINTS score was superior than ABCD2 in identifying AVS caused by stroke. From Carmona et al. (2016), HINTS had 100 % sensibility and 94,4% specificity and emphasized ataxia evaluation’s importance, once all patients with central etiology had a grade of ataxia. Krishnan et al. (2019) HINTS had 59,9% Negative Predictive Value (NPV) and 97,2 % Positive Predictive Value (PPV) related to stroke, same PPV was found by Sankalia et al. (2021). Ohle et al. (2020) observed that HINTS done by a neurologist was more accurate than studies that mixed neurologists and emergency physicians. Dmitriew et al. (2021) saw that HINTS was used wrongly in non-specific emergency departments, once only 3,1% patients tested had AVS and 96,9% wrongly tested had false positives. Conclusion: The HINTS is a valuable instrument in the clinical use and the training for better practical application needs incentive in emergency departments.

Abstract P753: Comparison of Calibration vs Non-Calibration Techniques in the Automated Capture of Eye Movement Data: Initial Validation of the Roadie Device for Detecting Posterior Circulation Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohamed Hassan ◽  
Chad Aldridge ◽  
Yan Zhuang ◽  
Timothy L McMurry ◽  
Gustavo Rohde ◽  
...  
Keyword(s):  
Eye Movements ◽  
Eye Tracking ◽  
Smooth Pursuit ◽  
Strong Correlation ◽  
Posterior Circulation ◽  
Screening Tools ◽  
Moderate Correlation ◽  
Posterior Circulation Stroke ◽  
Initial Validation ◽  
Acute Vestibular Syndrome

Background: Posterior circulation stroke (PCS) accounts for ~20% of ischemic strokes. Existing EMS screening tools lack accuracy in the diagnosis of PCS. We aim to develop an automated screening tool to detect abnormal eye movements in patients presenting with PCS. Methods: As an initial step, we built a portable platform called RoADIE (Rolling Apparatus to Detect Impairment of the Eyes), equipped with eye-tracking software to acquire gaze data from patients presenting with PCS, acute vestibular syndrome, and normal controls. We first performed a validation study in 19 healthy controls comparing calibration (C) vs non-calibration (NC) techniques. Eye movements were captured using a standard H-Test exam. The NC condition was performed first for each volunteer to avoid a learning effect. Correlation between C and NC tests was determined using the Spearman coefficient (r). Results: Conjugate gaze (i.e. ability of eyes to track in unison) demonstrated strong correlation along the horizontal [r = 0.976 (C), 0.922 (NC)] and vertical axes [r= 0.866 (C), 0.881(NC)]. Smooth pursuit (i.e. ability of each eye to track moving target) also showed strong correlation in the horizontal plane: right eye [r = 0.945 (C), 0.946 (NC), left eye [r=0.945 (C), 0.943 (NC)]. Vertical tracking showed moderate correlation: right eye [r=0.652 (C), 0.575 (NC), left eye [r=0.678 (C), 0.550 (NC)]. Conclusion: In this initial validation test of a portable eye tracking platform, we demonstrated strong correlation for both conjugate gaze and smooth pursuit in the horizontal axis, and moderate correlation for eye tracking in the vertical axis. Given similar performance in non-calibrated tests, a calibration procedure may not be necessary for future data capture. Next steps will include validation of the eye tracking device in prospective patients presenting with PCS and acute vestibular syndrome. Acknowledgement: Funding support through AHA Innovative Project Award 19IPLOI34760692

scholarly journals Az akut vestibularis szindróma sürgősségi diagnosztikájával szerzett tapasztalatok

2017 ◽  
Vol 158 (51) ◽  
pp. 2029-2040
Author(s):  
T. László Tamás ◽  
Tibor Garai ◽  
István Király ◽  
Andrea Mike ◽  
Csaba Nagy ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diagnostic Accuracy ◽  
Emergency Room ◽  
Posterior Circulation ◽  
Cranial Computed Tomography ◽  
Lower Sensitivity ◽  
Posterior Circulation Stroke ◽  
Bedside Test ◽  
Imaging Results ◽  
Acute Vestibular Syndrome

Abstract: Introduction and aim: To diagnose acute vestibular syndrome (AVS) in a prospective study by a new bedside test (providing 1A evidence) based on oculomotor analysis and assessment of hearing loss. To assess the frequency of central and peripheral causes of acute vestibular syndrome in the emergency room. To establish the diagnostic accuracy of acute cranial computed tomography as compared to oculomotor analysis done by video oculography goggles and audiometry. Method: Between 1st March 2016 and 1st March 2017 we documented 125 patients (62 women, 63 men, average age 53 years) in the emergency room of the Petz Aladár County Teaching Hospital using the above bedside and instrumental testing. Diagnosis was verified by cranial magnetic resonance imaging. Results: According to the results of the instrumental examination in AVS in 67% we found a peripheral cause and in 33% a central pathology. In 62% isolated posterior circulation stroke manifested itself by isolated vertigo without additional focal signs and the acute cranial computed tomography showed negative results in 96%. The instrumental examination increased diagnostic accuracy by making the diagnosis of isolated inferior semicircular canal vestibular neuritis possible. Conclusions: The new bedside oculomotor test is suitable for the diagnosis of posterior circulation stroke manifesting with isolated vertigo in early cases, when the routine neuroradiologic methods have a lower sensitivity or are not available. Orv Hetil. 2017; 158(51): 2029–2040.

scholarly journals Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department

2021 ◽  
Author(s):  
Agustín Julián-Jiménez ◽  
◽  
Juan González del Castillo ◽  
Eric Jorge García-Lamberechts ◽  
Rafael Rubio Díaz ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Predictive Value ◽  
Emergency Departments ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Community Acquired Pneumonia ◽  
Prognostic Performance ◽  
Operating Characteristic Curve

Objective. To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. Patients and methods. Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. Results. A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. Conclusion. The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

Paramedic Interpretation of Prehospital Lead-II ST-Segments

1997 ◽  
Vol 12 (2) ◽  
pp. 70-73 ◽  
Author(s):  
Robert Hill ◽  
Michael Heller ◽  
Alexander Rosenau ◽  
Scott Melanson ◽  
David Pronchik ◽  
...  
Keyword(s):  
Emergency Department ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Prehospital Setting ◽  
Emergency Medical Technician ◽  
Emergency Physicians ◽  
Emergency Medical ◽  
St Segment ◽  
St Segments

AbstractObjective:To determine the reliability of ST-segment interpretation by paramedics from lead-II rhythm strips obtained in the prehospital setting.Design:Prospective, blinded study of 127 patients transported by an urban/rural emergency medical services system with complaints consistent with ischemic heart disease.Methods:Emergency department physicians asked emergency medical technician-paramedics (EMT-P) via radio to evaluate ST-segments for elevation or depression and grade it as “mild,” “moderate,” or “severe.” Then, this rhythm strip was interpreted blindly by emergency physicians who also interpreted the lead-II obtained from a 12-lead electrocardiogram (ECG) obtained in the emergency department (ED). The field interpretation was compared with the subsequent readings and the final in-patient diagnosis using positive predictive value (PPV), negative predictive value (NPV), and the Kappa statistic. Markedly discrepant interpretations were analyzed separately.Results:Using physician interpretation as the reference standard, paramedic interpretation of the lead-II ST-segments obtained in the prehospital setting was correct (within ±1 gradation) in 113 out of 127 total cases (89%). Of 105 patients for whom final hospital diagnosis was available, the ST-segment on the rhythm strip obtained in the prehospital setting, had a positive predictive value of 74% and a negative predictive value of 85% for myocardial ischemia or myocardial infarction (MI) (p <0.001, Kappa = 0.59). Discordant interpretations between the paramedics and emergency physicians often were related to a basic misunderstanding of rhythm strip morphology.Conclusion:Field interpretation of ST-segments by paramedics is fairly accurate as judged both by emergency physicians and correlation with final patient outcome, but its clinical utility is unproved. A small but clinically significant number of outliers, consisting of markedly discrepant false positives, reflects paramedic uncertainty in identifying the deviations of the ST-segment.

scholarly journals The role of transcranial Doppler ultrasonography in differential diagnosis of vertigo in the Emergency Department

2019 ◽  
Vol 15 (3) ◽  
Author(s):  
Antonio Siniscalchi ◽  
Giovanni Malferrari
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Transcranial Doppler ◽  
Neurological Diseases ◽  
Low Cost ◽  
Color Doppler ◽  
Subsequent Treatment ◽  
Posterior Circulation ◽  
Posterior Circulation Stroke ◽  
Acute Vestibular Syndrome

Vertigo represents about 4% of access to the Emergency Department (ED). Several conditions, such as general medical illnesses, otovestibular diseases and neurological diseases (including posterior circulation stroke) cause acute vertigo. The incidence of cerebrovascular disease in patients with vertigo in ED varies from 3 to 5%. Although neurosonology studies on acute vestibular syndrome are scarce, the use of transcranial Doppler (TCD) and transcranial color Doppler (TCCD) in the management of vertigo patients has several advantages: it can be performed at the patient's bedside and repeated and, furthermore, its use is low-cost. In an acute stroke, with an experienced doctor, it can help distinguish an ischemic stroke from a hemorrhagic stroke. In acute central vertigo induced by posterior circulation stroke, the TCD or TCCD can be a screening test before angiographic neuroradiological studies for stenosis of vertebral or basal arteries. As a matter of fact, the clinical outcome, particularly in the posterior circulation stroke, is mainly related to a rapid diagnosis and subsequent treatment that will be able to quickly restore the blood flow. In conclusion, TCD and TCCD are useful in the differential diagnosis of vertigo in the ED, although we recognize the indisputable importance of clinical examination as a first step in vertigo management. In the evaluation of patients with acute central vertigo due to suspected posterior circulation stroke, the use of TCD or TCCD can rapidly reveal steno-occlusive disease of the posterior circulation, arterial dissections and give indirect signs of vertebra-basilar insufficiency.

scholarly journals Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department

2021 ◽  
pp. 197140092098866
Author(s):  
Angela Guarnizo ◽  
Kevin Farah ◽  
Daniel A Lelli ◽  
Darren Tse ◽  
Nader Zakhari
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Positive Predictive Value ◽  
Head And Neck ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Posterior Circulation ◽  
Emergency Department Presentation ◽  
Ct Angiogram ◽  
Computed Tomography Angiogram

Objective To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head. Methods Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings. Results One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%. Conclusion Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.

scholarly journals Using emergency physicians’ abilities to predict patient admission to decrease admission delay time

2020 ◽  
Vol 37 (7) ◽  
pp. 417-422
Author(s):  
Erica E M Lee ◽  
Edmund S H Kwok ◽  
Christian Vaillancourt
Keyword(s):  
Cohort Study ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Hospital Admissions ◽  
Patient Admission ◽  
Myocardial Infarctions ◽  
Emergency Physicians ◽  
Convenience Sample ◽  
Sensitivity Specificity ◽  
Ed Crowding

BackgroundIn many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs’ abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation.MethodsWe conducted a prospective cohort study in an academic centre in Canada between October 2017 and February 2018 using a convenience sample of ED patient encounters requiring consultation. We excluded patients under 18 years or those clearly likely to be admitted (traumas, strokes, S-T elevation myocardial infarctions and Canadian Triage and Acuity Scale of 1). EPs predicted patient admission just before consultation. Potential ED stretcher time saved was estimated for correctly predicted admissions assuming bed requests were initiated with consultation and a constant time to inpatient bed.ResultsCharacteristics of 454 patients were: mean age 60.1 years, 48.5% male, 46.9% evening presentation, 69.4% admitted and median time to bed request of 3.5 hours (IQR 2.0–5.3 hours). Overall, EPs prediction sensitivity, specificity, positive predictive value and negative predictive value were 90.5% (95% CI 86.7% to 93.5%), 84.2% (95% CI 77.0% to 89.8%), 92.8% (95% CI 89.8% to 95.0%) and 79.6% (95% CI 73.4% to 84.7%). Approximately 922.1 hours of ED stretcher time could have been saved during the 5-month study period if EPs initiated a bed request with consultation.ConclusionCrowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED.

scholarly journals Video-Oculography-Assisted Head Impulse Test and Caloric Testing for Detecting Stroke in Acute Vertigo Patients via Modified HINTS Plus

2021 ◽  
Vol 10 (19) ◽  
pp. 4471
Author(s):  
Timo Siepmann ◽  
Cosima Gruener ◽  
Erik Simon ◽  
Annahita Sedghi ◽  
Hagen H. Kitzler ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Posterior Circulation ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Caloric Testing ◽  
Patients Âgés ◽  
Video Oculography ◽  
Posterior Circulation Stroke ◽  
Acute Vestibular Syndrome ◽  
Cranial Mri

Background: We assessed whether detection of stroke underlying acute vertigo using HINTS plus (head-impulse test, nystagmus type, test of skew, hearing loss) can be improved by video-oculography for automated head-impulse test (V-HIT) analysis. Methods: We evaluated patients with acute vestibular syndrome (AVS) presenting to the emergency room using HINTS plus and V-HIT-assisted HINTS plus in a randomized sequence followed by cranial MRI and caloric testing. Image-confirmed posterior circulation stroke or vertebrobasilar TIA were the reference standards to calculate diagnostic accuracy. We repeated statistical analysis for a third protocol that was composed post hoc by replacing the head-impulse test with caloric testing in the HINTS plus protocol. Results: We included 30 AVS patients (ages 55.4 ± 17.2 years, 14 females). Of these, 11 (36.7%) had posterior circulation stroke (n = 4) or TIA (n = 7). Acute V-HIT-assisted HINTS plus was feasible and displayed tendentially higher accuracy than conventional HINTS plus (sensitivity: 81.8%, 95% CI 48.2–97.7%; specificity 31.6%, 95% CI 12.6–56.6% vs. sensitivity 72.7%, 95% CI 39.0–94.0%; specificity 36.8%, 95% CI 16.3–61.6%). The new caloric-supported algorithm showed high accuracy (sensitivity 100%, 95% CI 66.4–100%; specificity 66.7%, 95% CI 41–86.7%). Conclusions: Our study provides pilot data on V-HIT-assisted HINTS plus for acute AVS assessment and indicates the diagnostic value of integrated acute caloric testing.

Sign in / Sign up

Export Citation Format

Share Document