METHODS: We performed a systematic search (MEDLINE/Embase) to identify studies reporting on the diagnostic accuracy of bedside examinations in adults with acute vestibular syndrome. Diagnostic test properties were calculated for findings using a random-effects model. Results were stratified by GTI-rating used.
RESULTS: We identified 6515 articles and included 18 studies (n = 1025 patients). Ischemic strokes (n = 665) and acute unilateral vestibulopathy (n = 306) were most frequent. Grade 2/3 GTI had moderate sensitivity (70.8% [95% confidence-interval (CI) = 59.3-82.3%]) and specificity (82.7 [71.6-93.8%]) for predicting a central cause, whereas grade 3 GTI had a lower sensitivity (44.0% [34.3-53.7%] and higher specificity (99.1% [98.0-100.0%]). In comparison, diagnostic accuracy of HINTS (sensitivity = 96.8% [94.8-98.8%]; specificity = 97.6% [95.3-99.9%]) was higher. When combining central nystagmus-patterns and grade 2/3 GTI, sensitivity was increased to 76.4% [71.3-81.6%] and specificity to 90.3% [84.3-96.3%], however, no random effects model could be used. Sensitivity was higher in studies using the GTI rating (grade 2/3) by Lee (2006) compared to the approach by Moon (2009) (73.8% [69.0-78.0%] vs. 57.4% [49.5-64.9%], p = 0.001).
CONCLUSIONS: In comparison to HINTS, the diagnostic accuracy of GTI is inferior. When combined with central nystagmus-patterns, diagnostic accuracy could be improved based on preliminary findings. GTI can be readily applied in the ED-setting and also in patients with acute imbalance syndrome.
方法:我们进行了系统检索(MEDLINE/Embase),以确定报告成人急性前庭综合征床旁检查诊断准确性的研究。使用随机效应模型计算诊断测试特性。结果通过使用的GTI评级进行分层。
结果:我们确定了6515篇文章,包括18项研究(n=1025名患者)。缺血性中风(n=665)和急性单侧前庭病变(n=306)最常见。2/3级GTI具有中等敏感性(70.8%[95%置信区间(CI)=59.3-82.3%])和特异性(82.7[71.6-93.8%]),用于预测中心原因,而3级GTI的敏感性较低(44.0%[34.3-53.7%],特异性较高(99.1%[98.0-100.0%]).相比之下,HINTS的诊断准确性(敏感性=96.8%[94.8-98.8%];特异性=97.6%[95.3-99.9%])更高.当结合中枢眼震模式和2/3级GTI时,敏感性提高到76.4%[71.3-81.6%],特异性提高到90.3%[84.3-96.3%],然而,不能使用随机效应模型。与Moon(2009)的方法相比,Lee(2006)使用GTI评级(2/3级)进行的研究的敏感性更高(73.8%[69.0-78.0%]与57.4%[49.5-64.9%],p=0.001)。
结论:与HINTS相比,GTI的诊断准确性较差。当结合中央眼震模式时,根据初步发现,可以提高诊断准确性.GTI可以很容易地应用于ED设置以及急性失衡综合征患者。