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

Abstract

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.