Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

---

影响加拿大急诊医学医师使用 HINTS 考试的因素

目标

HINTS 检查（头冲动、眼球震颤、偏斜试验）是一种床边体检技术，可以区分中风引起的眩晕和更良性的外周前庭病。急诊医学 (EM) 医生对这项检查的接受度很低；因此，我们对加拿大 EM 医生进行了调查，以确定何时采用 HINTS 考试，以及哪些因素导致其采用率低。

方法

我们设计并测试了一项包含 26 个问题的在线调查，并通过电子邮件将其分发给在加拿大急诊医师协会 (CAEP) 注册的 EM 医师，并附有 3 周和 5 周的提醒电子邮件以提高完成率。这项匿名调查没有参与动机，由 185 名 EM 医生完成，他们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。

结果

88 名受访者 (47.8%) 在眩晕检查中始终使用 HINTS 检查，117 名 (63.7%) 在临床实用性有限的情况下使用它。后者在非学术环境中工作的医生中更为常见，没有 5 年的 EM 住院医师培训，并且有更长的实践时间 ( p  < 0.01)。最常见的未使用解释是不需要 HINTS 检查、EM 医生对检查缺乏验证以及对甩头测试的担忧。

结论

尽管 HINTS 考试的使用很常见，但仍需要进行有关何时应用以及如何应用的教育，尤其是关于甩头测试。我们所附的规则可能有助于此，但质量改进计划是有保证的。吸收率低的部分原因是 EM 医生缺乏对这项检查的验证，因此应努力进行专门由 EM 医生参与的精心设计的 HINTS 试验。