Review Clarifies Appropriate HINTS Examination Use in Patients With Acute Dizziness

A review in JAMA Neurology examines appropriate use of the Head Impulse, Nystagmus, Test of Skew (HINTS) examination to distinguish peripheral vestibular disorders from central causes, including stroke, in acute vestibular syndrome. The authors describe persistent confusion about patient selection and interpretation since the examination was introduced in 2009.

The review identifies patients with continuous dizziness and spontaneous nystagmus at rest as the population in whom HINTS is most effective. Common errors include applying the examination to patients without nystagmus, failing to screen for central features beforehand, and misinterpreting individual components. The authors report that studies show high stroke-detection sensitivity with correct application but substantially lower diagnostic accuracy in inappropriate populations. The available abstract provides no numerical accuracy estimates or study counts.

For clinicians, the central recommendation is to screen for central features before considering HINTS and restrict its use to patients with nystagmus at rest. The authors also argue that ambiguities in guidelines and educational resources, including GRACE-3, may contribute to misuse. This is a review rather than a new diagnostic study; without the full text, its evidence-selection methods and supporting estimates cannot be assessed.