Perez Nicolas, Rama-Lopez Julio
Department of Otolaryngology, University Hosptial and Medical School, University of Navarra, Spain.
Otol Neurotol. 2003 Nov;24(6):913-7. doi: 10.1097/00129492-200311000-00016.
To test the performance of the head-impulse and caloric tests in terms of sensitivity, specificity, and predictive efficiency.
This was an open and prospective study conducted at a tertiary care center in which 265 patients were subjected to the head-impulse test and caloric test on the same day. The results of the head-impulse test were considered as normal or pathologic. In a similar way, the caloric test was rated as normal when the difference in canal paresis was less than 22 percent and directional preponderance less than 28 percent, and abnormal if canal paresis was more than 22 percent and/or directional preponderance was more than 28 percent.
The results of each test were compared with obtain the specificity, sensitivity, and positive and negative predictive values. A receiver operating characteristics (ROC) curve was obtained from the false-alarm rate and the hit rate value of the head impulse test.
The specificity of the head impulse test was 0.91 and the sensitivity was 0.45. The positive predictive value was 0.92, the negative predictive value was 0.41, and the area under the ROC curve was 0.866. A canal paresis value of 42.5 percent was considered to be the limit of the normal response, as seen when the head impulse test was used to predict a normal or abnormal result in a given patient.
The head impulse test, when used as a bedside test, and the caloric test are by no means redundant methods. The information obtained form both can be used in combination to obtain a better insight into the degree of vestibular dysfunction of patients.
从敏感性、特异性和预测效率方面测试摇头试验和冷热试验的性能。
这是一项在三级医疗中心进行的开放性前瞻性研究，265例患者在同一天接受了摇头试验和冷热试验。摇头试验的结果被视为正常或异常。同样，当半规管轻瘫差异小于22%且方向优势小于28%时，冷热试验被评为正常；如果半规管轻瘫超过22%和/或方向优势超过28%，则为异常。
比较每项试验的结果以获得特异性、敏感性、阳性和阴性预测值。从摇头试验的误报率和命中率值获得受试者工作特征（ROC）曲线。
摇头试验的特异性为0.91，敏感性为0.45。阳性预测值为0.92，阴性预测值为0.41，ROC曲线下面积为0.866。当使用摇头试验预测给定患者的正常或异常结果时，42.5%的半规管轻瘫值被认为是正常反应的极限。
作为床边试验使用时，摇头试验和冷热试验绝不是多余的方法。从两者获得的信息可以结合使用，以更好地了解患者前庭功能障碍的程度。
