Department of Medicine, Division of Neurology, McMaster University, Hamilton, ON, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
CJEM. 2022 Nov;24(7):710-718. doi: 10.1007/s43678-022-00365-2. Epub 2022 Sep 15.
The HINTS examination (head impulse, nystagmus, test of skew) is a bedside physical examination technique that can distinguish between vertigo due to stroke, and more benign peripheral vestibulopathies. Uptake of this examination is low among Emergency Medicine (EM) physicians; therefore, we surveyed Canadian EM physicians to determine when the HINTS exam is employed, and what factors account for its low uptake.
We designed and tested a 26-question online survey, and disseminated it via email to EM physicians registered with the Canadian Association of Emergency Physicians (CAEP), with 3 and 5-week reminder emails to increase completion. This anonymous survey had no incentives for participation, and was completed by 185 EM physicians, with post-graduate medical training in either Emergency Medicine or Family Medicine. The primary outcomes were the frequencies of various responses to survey questions, with secondary outcomes being the associations between participant characteristics and given responses.
88 respondents (47.8%) consistently use the HINTS examination in the work-up of vertigo, and 117 (63.7%) employ it in scenarios where its clinical utility is limited. The latter is more common among physicians working in non-academic settings, without 5-year EM residency training, and with greater years of practice (p < 0.01). The most frequent explanations for non-use were a lack of need for the HINTS examination, the lack of validation of the exam among EM physicians, and concerns surrounding the head-impulse test.
Though HINTS exam usage is common, there is a need for education on when to apply it, and how to do so, particularly as concerns the head-impulse test. Our attached rubric may assist with this, but quality-improvement initiatives are warranted. Low uptake is partly due to the lack of validation of this examination among EM physicians, so effort should be made to conduct well-designed HINTS trials exclusively involving EM physicians.
HINTS 检查（头部脉冲、眼震、偏斜试验）是一种床边体格检查技术，可区分因中风引起的眩晕和更良性的周围前庭病变。急诊医学（EM）医生对这项检查的接受程度较低；因此，我们对加拿大的 EM 医生进行了调查，以确定他们何时使用 HINTS 检查，以及哪些因素导致其接受程度低。
我们设计并测试了一份 26 个问题的在线调查，并通过电子邮件分发给加拿大急诊医师协会（CAEP）注册的 EM 医生，通过 3 次和 5 次提醒电子邮件以提高完成率。这项匿名调查没有参与的激励措施，共有 185 名 EM 医生完成了调查，他们都接受过急诊医学或家庭医学的研究生医学培训。主要结果是对调查问题的各种回答的频率，次要结果是参与者特征与给定回答之间的关联。
88 名受访者（47.8%）在眩晕的检查中始终使用 HINTS 检查，117 名受访者（63.7%）在其临床效用有限的情况下使用该检查。后者在非学术环境中工作的医生、没有 5 年的 EM 住院医师培训和从业时间较长的医生中更为常见（p<0.01）。不使用 HINTS 检查的最常见解释是不需要进行 HINTS 检查、EM 医生对该检查缺乏验证以及对头部脉冲检查的担忧。
尽管 HINTS 检查的使用较为普遍，但仍需要对何时应用以及如何应用进行教育，特别是考虑到头脉冲检查。我们的附加评估表可能有助于这一点，但需要进行质量改进举措。接受程度低部分是由于 EM 医生对该检查缺乏验证，因此应努力专门针对 EM 医生进行精心设计的 HINTS 试验。
