Assessment tool helps improve acute vertigo diagnosis
Research by our Neurosciences and Physiotherapy team has demonstrated the importance of an assessment tool to improve speed and clarity of acute vertigo diagnosis.
Rebecca Rayner, Clinical Lead Physiotherapist, Dr Chit Hmu, Stroke Consultant, and Joseph Hartley-Palmer, Lecturer in Physiotherapy at the University of East Anglia have had their quality improvement (QI) work published in The Journal of Laryngology & Otology.
The published study looked at a diagnostic framework to help improve the clinical pathway for patients with Acute Vestibular Syndrome (AVS).
Acute Vestibular Syndrome is a form of vertigo that can arise without warning, lasts at least 24 hours or more, with recovery often lasting from weeks to months.
The use of the Head Impulse, Nystagmus, Test of Skew, (HINTS) assessment has been used to aid diagnosis of Acute Vestibular Syndrome in the hyperacute stroke setting here at NNUH since Rebecca provided education to the medical, physiotherapy and stroke alert nurse team back in 2019.
Rebecca said: “It is difficult to accurately diagnose AVS, and to know whether someone is having a stroke at the back of their brain or there is a problem with the inner ear (vestibular) system. Successful use of the HINTS framework aids effective diagnosis and ultimately, better treatment of those conditions.”
Dr Chit Hmu, Consultant Stroke Physician, tested the effectiveness of HINTS and had 100% diagnostic accuracy for patients on the acute stroke pathway and followed up with an MRI. Alongside this, additional training was given to the stroke and Emergency Department multi-disciplinary team (MDT) to enable better identification of when to use the HINTS test.
While the HINTS assessment use is not currently widespread, the team is hopeful to see wider adoption following the success of this trial.
Dr Hmu said: “We found HINTS when used with usual neurological assessment is safe to rule out major posterior circulation stroke in patients presenting with AVS. The assessment training was subsequently provided on a wider scale to the stroke consultant and registrar team, stroke alert nurses, some accident and emergency registrars and advanced clinical practitioners, and more intensely to senior physiotherapists within the acute stroke pathway.”
Rebecca Rayner said: “Most of our NNUH Neurosciences Physiotherapy team and several of the medical team are now competent in using the HINTS assessment to aid diagnosis of a stroke or inner ear problem, which helps patients get the right treatment quicker.”
Following from the success of the study, the HINTS assessment has continued to be used in the Neurosciences Department at NNUH with positive results, and further research on the topic is planned.