Abstract：
BACKGROUND: In patients presenting with acute prolonged vertigo and/or gait imbalance, the HINTS [Head-Impulse, Nystagmus, Test-of-Skew] are very valuable. However, their application may be limited by lack of training and absence of vertigo/nystagmus. Alternatively, a graded gait/truncal-instability (GTI, grade 0-3) rating may be applied.
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.
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.
摘要：
背景：在出现急性延长性眩晕和/或步态失衡的患者中，提示[头部冲动，眼球震颤,偏斜测试]非常有价值。然而,它们的应用可能受到缺乏训练和没有眩晕/眼球震颤的限制。或者，分级步态/躯干不稳定(GTI，可以应用0-3级)评级。
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。
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。
