Comparing HINTS Exam, TriAGe+ Score, and ABCD2 Score for Stroke Prediction in Acute Vertigo Patients in the ED
Authors: Ayse Cagla Ozmert Toplu, Isıl Kalyoncu Aslan, Ebru Unal Akoglu, Tuba Cimilli Ozturk
Journal: American Journal of Emergency Medicine, February 2025
Key Findings:
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HINTS Exam had perfect sensitivity (100%) → best for ruling out stroke (negative LR = 0.0).
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TriAGe+ had the best specificity (96.3%) → best for confirming stroke (positive LR = 12.65).
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ABCD2 score performed poorly compared to both HINTS and TriAGe+.
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HINTS and TriAGe+ had similar overall diagnostic accuracy (AUC = 0.88).
Conclusion & Clinical Implications:
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HINTS is the best exclusion tool but requires clinical expertise in performing the exam reliably.
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TriAGe+ is highly specific and can be a practical tool in busy ED settings.
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ABCD2 score is less useful in acute vertigo cases.
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Recommendation: HINTS for trained clinicians, TriAGe+ for rapid ED assessment when expertise is limited.
Methods:
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Study Design: Prospective observational study at a single center
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Patients: 357 ED patients with isolated dizziness or vertigo
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Primary Outcome: Diagnostic accuracy of HINTS, ABCD2, and TriAGe+ for stroke prediction
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Gold Standard: Stroke diagnosis confirmed via neuroimaging
Results:
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Total patients: 357
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Confirmed strokes: 58
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Diagnostic accuracy:
|
Test |
Sensitivity |
Specificity |
AUC |
Likelihood Ratios |
|
HINTS Exam |
100% |
85.9% |
0.88 |
Negative LR = 0.0 (Excellent exclusion) |
|
TriAGe+ (≥10) |
46.6% |
96.3% |
0.88 |
Positive LR = 12.65 (Excellent confirmation) |
|
ABCD2 (≥4) |
65.5% |
68.6% |
0.71 |
Poorer predictive power |
Toplu, A.C.O., Aslan, I.K., Akoglu, E.U. and Ozturk, T.C., 2025. The role of the HINTS exam, Triage+ score. The American Journal of Emergency Medicine.