Diagnostic accuracy of HINTS Plus test in the differential diagnosis of central and peripheral vertigo: a prospective, cross-sectional study

We evaluated the diagnostic accuracy of the HINTS Plus tool in differentiating central vertigo from peripheral vertigo in the emergency department, using neuroimaging as the reference standard.

If findings confirm high sensitivity and specificity for HINTS Plus in the ED, audiologists and physicians working in vestibular settings should be aware of its diagnostic value; however, clinical adoption depends on full published results, examiner training, and local protocol — no immediate practice change warranted until the complete data are reviewed.

Reliable bedside differentiation of central from peripheral vertigo in the ED could reduce unnecessary neuroimaging, speed stroke identification, and inform when audiology or neurology referral is most urgent.

1. 01Prospective, cross-sectional design evaluated HINTS Plus as a bedside vestibular diagnostic tool in the ED.
2. 02HINTS Plus combines Head Impulse test, Nystagmus assessment, Test of Skew, and hearing evaluation (Plus) at the bedside.
3. 03Neuroimaging served as the reference standard for central vs. peripheral vertigo classification.
4. 04Published in BMC Emergency Medicine (DOI: 10.1186/s12873-026-01675-9; PMID: 42399767).
5. 05Findings have direct relevance for emergency physicians, neurologists, and audiologists managing acute dizziness.

PMID

42399767

DOI

10.1186/s12873-026-01675-9.

Journal

BMC Emergency Medicine

Publication type

research_article

Evidence level

2b

Population

Patients presenting to the emergency department with acute vertigo

Intervention

HINTS Plus bedside examination (Head Impulse, Nystagmus, Test of Skew, plus hearing assessment)

Comparator

Neuroimaging (reference standard)