Diagnostic Accuracy of HINTS Plus Test in the Differential Diagnosis of Central and Peripheral Vertigo: A Prospective, Cross-Sectional Study

Background 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. Methods This cross-sectional study included adult patients with acute vestibular syndrome without focal neurological deficits. Crucially, all patients underwent neuroimaging with non-contrast brain tomography and magnetic resonance imaging to definitively exclude central pathology. Diagnostic accuracy of the HINTS Plus test was assessed by comparing bedside findings with neuroimaging results. Results Of 298 patients enrolled, 62 had central and 236 peripheral vertigo patients. The sensitivity and specificity of the HINTS Plus for detecting central vertigo were 80.65% (95% CI: 68.63–89.58) and 82.63% (95% CI: 77.18–87.24), respectively. The Head Impulse Test demonstrated the highest sensitivity (70.97%) among individual components. Conclusion In our study, HINTS Plus sensitivity was lower than reported in literature. Consequently, the test is not sufficiently reliable to rule out central vertigo in isolation. We concluded that neuroimaging remains the standard of care for acute vestibular syndrome, even when HINTS Plus suggests a peripheral etiology.