Guidelines

Edlow JA, Carpenter C, Akhter M, Khoujah D, Marcolini E, Meurer WJ, et al. Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Academic Emergency Medicine. 2023 May 1;30(5):442–86.

Very good general reading

Saber Tehrani AS, Coughlan D, Hsieh YH, Mantokoudis G, Koroshetz WJ, Newman-Toker DE. Diagnosing Stroke in Acute Dizziness and Vertigo: Pitfalls and Pearls. Stroke. 2018 Mar;49(3):788-795.

Edlow JA. Diagnosing dizziness: we are teaching the wrong paradigm! Acad Emerg Med. 2013 Oct;20(10):1064-6.

Ohle R, Montpellier RA, Marchadier V, Wells GA, McIsaac S, Mercier E, et al. Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta-analysis. Acad Emerg Med. 2020 Sep;27(9):887-896.

Benton R, Hunter MD. Accuracy of the HINTS Exam for Vertigo in the Hands of Emergency Physicians. NEJM Journal Watch [Internet]. 2020 Apr 3 [cited 2024 Jan 3];2020. Available from: https://www.jwatch.org/NA51222/2020/04/03/accuracy-hints-exam-vertigo-hands-emergency-physicians

Tarnutzer AA, Berkowitz AL, Newman-Toker DE. Impact of Clinician Training Background and Stroke Location on Bedside Diagnostic Test Accuracy in the Acute Vestibular Syndrome - A Meta-Analysis. Ann Neurol. 2023 Aug;94(2):295-308.

Tarnutzer A, Edlow J. Bedside Testing in Acute Vestibular Syndrome-Evaluating HINTS Plus and Beyond-A Critical Review. Audiol Res [Internet]. 2023 Jan 9 [cited 2024 Mar 13];13(5). Available from: https://pubmed.ncbi.nlm.nih.gov/37736940/

Shah VP, Lammers OJES, Wears FL, Shapiro MS, Kapur A, Chandra A, et al. Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta-analysis for the guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med [Internet]. 2023 May [cited 2024 Sep 28];30(5). Available from: https://pubmed.ncbi.nlm.nih.gov/35876220/

Kalladka K, Barr JF, Barry DL, Millar WJ, Smith MA, Lewis LD, et al. Does intracerebral haemorrhage mimic benign dizziness presentations? A population based study. Emerg Med J [Internet]. 2012 Jan [cited 2024 Sep 28];29(1). Available from: https://pubmed.ncbi.nlm.nih.gov/21245473/

Polensek S, Tusa RJ. Nystagmus during attacks of vestibular migraine: an aid in diagnosis. Audiol Neurootol [Internet]. 2010 [cited 2023 Sep 2];15(4). Available from: https://pubmed.ncbi.nlm.nih.gov/19893305/

Edlow J, Beck F. Recognizing Posterior Circulation Transient Ischemic Attacks Presenting as Episodic Isolated Dizziness. Ann Emerg Med [Internet]. 2024 May 23 [cited 2024 Aug 16]; Available from: https://pubmed.ncbi.nlm.nih.gov/38795083/

STANDING Algorithm

Vanni, S., Pecci, R., Casati, C., Moroni, F., Risso, M., Ottaviani, M., Nazerian, P., & Grifoni, S. (2014). STANDING, a four-step bedside algorithm for differential diagnosis of acute vertigo in the Emergency Department. Acta Otorhinolaryngologica Italica, 34(6), 419–426. Available from: https://pubmed.ncbi.nlm.nih.gov/25762835

Vanni, S., Pecci, R., Edlow, J. A., Nazerian, P., Santimone, R., Pepe, G., Moretti, M., Pavellini, A., Caviglioli, C., Casula, C., Bigiarini, S., Vannucchi, P., & Grifoni, S. (2017). Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm. Frontiers in Neurology, 8. Available from: https://pubmed.ncbi.nlm.nih.gov/29163350/

Ceccofiglio, A., Pecci, R., Peruzzi, G., Rivasi, G., Rafanelli, M., Vanni, S., & Ungar, A. (2020). STANDING update: A retrospective analysis in the Emergency Department one year after its validation. Emergency Care Journal, 16. Available from: https://consensus.app/papers/standing-analysis-emergency-department-year-validation-ceccofiglio/a4e78b0ebd93582c947f8cee9df5d5cb/?utm_source=chatgpt

Gerlier, C., Fels, A., & Chatellier, G. (2023). Authors' reply to Sabour S. “The 4‐step STANDING algorithm for predicting central causes of vertigo; methodological issues on reliability, validity, and prediction”. Academic Emergency Medicine, 30. Available from: https://consensus.app/papers/authors-reply-4‐step-standing-algorithm-predicting-gerlier/7c14820584475d81bdcc82890c24608d/?utm_source=chatgpt

Nakatsuka, M., & Molloy, E. E. (2022). The HINTS examination and STANDING algorithm in acute vestibular syndrome: A systematic review and meta-analysis involving frontline point-of-care emergency physicians. PLoS ONE, 17. Available from: https://consensus.app/papers/hints-examination-standing-algorithm-acute-review-nakatsuka/bc412581abac50b780f304f7035edd4f/?utm_source=chatgpt

Gerlier, C., Fels, A., Hoarau, M., Vitaux, H., Mousset, C., Farhat, W., Firmin, M., Pouyet, V., Paoli, A., & Ganansia, O. (2021). Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS, STANDING, and ABCD2 tests: A diagnostic cohort study. Academic Emergency Medicine, 28(11), 1368–1378. Available from: https://consensus.app/papers/differentiating-causes-acute-emergency-setting-hints-gerlier/8b98bf6b19bb5973bfc102a117016d93/?utm_source=chatgpt

The TiTrATE algorithm

Newman-Toker, D., & Edlow, J. (2015). TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurologic Clinics, 33(3), 577-599. https://consensus.app/papers/titrate-novel-evidencebased-approach-diagnosing-acute-newmantoker/a2c51b789a015e63b830f362b20d2406/?utm_source=chatgpt

Filippopulos, F., Strobl, R., Belanovic, B., Dunker, K., Grill, E., Brandt, T., Zwergal, A., & Huppert, D. (2022). Validation of a comprehensive diagnostic algorithm for patients with acute vertigo and dizziness. European Journal of Neurology, 29, 3092-3101. https://consensus.app/papers/validation-algorithm-patients-dizziness-filippopulos/3dfc9eb90ec052af8e278330ce25f3e8/?utm_source=chatgpt

Edlow, J., Gurley, K. L., & Newman-Toker, D. (2018). A New Diagnostic Approach to the Adult Patient with Acute Dizziness. The Journal of Emergency Medicine, 54(4), 469-483. https://consensus.app/papers/approach-adult-patient-acute-dizziness-edlow/3f79296bff46521386c7b7ef7be7e922/?utm_source=chatgpt

The HINTS exam – the no bullshit Cochrane assessment

Gottlieb, M., Pourmand, G. D., & Chiu, J. N. (2023). Head Impulse, Nystagmus, and Test of Skew Examination for Diagnosing Central Causes of Acute Vestibular Syndrome. The Cochrane Database of Systematic Reviews, 11(11). https://pubmed.ncbi.nlm.nih.gov/37916744/

The HINTS exam – other sources

Hunter, B. R. (2020, April 3). Accuracy of the HINTS Exam for Vertigo in the Hands of Emergency Physicians. NEJM Journal Watch. Retrieved from https://www.jwatch.org/NA51222/2020/04/03/accuracy-hints-exam-vertigo-hands-emergency-physicians

Tarnutzer, A., & Edlow, J. (2023). Bedside Testing in Acute Vestibular Syndrome-Evaluating HINTS Plus and Beyond-A Critical Review. Audiology Research, 13(5). https://pubmed.ncbi.nlm.nih.gov/37736940/

O'Brien, R., Morgan, R. A., Meyer, V., Wright, A., Smith, M., & Asher, M. et al. (2020). Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta-analysis. Academic Emergency Medicine, 27(9). https://pubmed.ncbi.nlm.nih.gov/32167642/

Newman-Toker, D., Curthoys, I., & Halmagyi, G. M. (2015). Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the ‘Eye ECG’. Seminars in Neurology, 35(5). https://pubmed.ncbi.nlm.nih.gov/26444396/

Dmitriew, C., Regis, A., Bodunde, O., Lepage, R., Turgeon, Z., McIsaac, S., et al. (2021). Diagnostic Accuracy of the HINTS Exam in an Emergency Department: A Retrospective Chart Review. Academic Emergency Medicine, 28(4), 387–393.

Shah, V., Ojo, L. J. E. S., Wong, F., Moses, S., Benjamin, A. K., & Ching, A. et al. (2023). Diagnostic Accuracy of the Physical Examination in Emergency Department Patients with Acute Vertigo or Dizziness: A Systematic Review and Meta-analysis for GRACE-3. Academic Emergency Medicine, 30(5). https://pubmed.ncbi.nlm.nih.gov/36453134/

Giudice, C., Harrow, M., Fonseca, A., Vanni, H., Crowell, M., & Wright, F. et al. (2021). Differentiating Central from Peripheral Causes of Acute Vertigo in an Emergency Setting with the HINTS, STANDING, and ABCD2 Tests: A Diagnostic Cohort Study. Academic Emergency Medicine, 28(12). https://pubmed.ncbi.nlm.nih.gov/34245635/

Perry, J. J., Newman-Toker, D. E., & O'Brien, R. (2022). Editorial Regarding Byworth Article on HINTS Exam Use by Emergency Physicians. CJEM, 24(7). https://pubmed.ncbi.nlm.nih.gov/36279097/

Newman-Toker, D., Kerber, K. A., Hsieh, Y. H., Pula, J. H., O'Brien, R., & Southerland, S. T. et al. (2013). HINTS Outperforms ABCD2 to Screen for Stroke in Acute Continuous Vertigo and Dizziness. Academic Emergency Medicine, 20(10). https://pubmed.ncbi.nlm.nih.gov/24127701/

Kattah, J. C., Talkad, A. V., Wang, D. Z., Hsieh, Y. H., & Newman-Toker, D. E. (2009). HINTS to Diagnose Stroke in the Acute Vestibular Syndrome: Three-Step Bedside Oculomotor Examination More Sensitive Than Early MRI Diffusion-Weighted Imaging. Stroke, 40(11). https://pubmed.ncbi.nlm.nih.gov/19762709/

Tarnutzer, A. A., Goeldlin, R. A., Weber, Z., Rickli, K. A., Kim, J. C., & Goddard, M. et al. (2023). Impact of Clinician Training Background and Stroke Location on Bedside Diagnostic Test Accuracy in the Acute Vestibular Syndrome - A Meta-Analysis. Annals of Neurology, 94(2). https://pubmed.ncbi.nlm.nih.gov/37038843/

Ooi, S., Pushpanathan, G., Tan, T., Chua, L., Fonseca, A., & Lee, J. et al. (2023). Meta-Analysis of the Use of Head Impulse Test and Head Impulse Test with Direction Changing Nystagmus and Test of Skew Deviation in the Diagnosis of Peripheral Vertigo and Stroke. Cerebrovascular Diseases, 52(2). https://pubmed.ncbi.nlm.nih.gov/36088909/

Nham, B., Wang, C., Reid, N., Calic, Z., Kwok, B. Y. C., & Black, D. A. et al. (2023). Modern Vestibular Tests Can Accurately Separate Stroke and Vestibular Neuritis. Journal of Neurology, 270(4), 2031–2041.

Lee, D. H., Schneider, E., Lee, S. Y., Kim, J. S., & Koo, J. W. (2022). Objective Measurement of HINTS (Head Impulse, Nystagmus, Test of Skew) in Peripheral Vestibulopathy. Auris Nasus Larynx, 49(6), 938–949.