Background and purpose Acute vestibular syndrome (AVS) typically manifests as isolated dizziness or vertigo with no apparent neurological impairments. However, distinguishing life-threatening stroke from innocuous peripheral vestibular lesions in the emergency room (ER) remains challenging. This study aimed to explore the ability of the head impulse-nystagmus-test of skew (HINTS) combined with truncal ataxia or ABCD2 score to differentiate stroke from peripheral vestibular disease in patients with AVS in the ER. Methods We prospectively recruited 121 patients with AVS from December 2022 to June 2023, 69 of whom presented with vestibular neuritis (VN) and the remaining with posterior circulation stroke (PCS). We analysed the HINTS results, truncal ataxia and ABCD2 score and compared the sensitivity and specificity among HINTS, truncal ataxia, ABCD2 score and their combinations using the McNemar test for paired samples. Results HINTS combined with grade 2-3 truncal ataxia achieved significantly higher sensitivity than that of isolated HINTS in differentiating PCS from VN (100% vs 88.5%, p=0.031). The specificity of HINTS plus grade 2-3 truncal ataxia did not significantly differ from that of isolated HINTS (p=0.125); however, the combination of ABCD2 score and HINTS did not improve the diagnostic accuracy. The sensitivity of ABCD2 score ≥4 plus grade 2-3 truncal ataxia was significantly higher than those of isolated ABCD2 score ≥4 or isolated grade 2-3 truncal ataxia (p=0.016 and p<0.001, respectively) and not significantly lower than that of isolated HINTS (p=0.508). Conclusion Compared with the ABCD2 score, the truncal ataxia is of more valuable assistance to HINTS in differentiating PCS. Although the combination of ABCD2 score and truncal ataxia has a significant implication, it is not a replacement for HINTS. Data are available on reasonable request. The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

中文翻译：

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急诊室床边HINTS、ABCD2评分和躯干共济失调鉴别小脑脑干卒中和前庭神经炎的应用

背景和目的急性前庭综合征（AVS）通常表现为孤立的头晕或眩晕，没有明显的神经功能障碍。然而，在急诊室 (ER) 中区分危及生命的中风和无害的周围前庭病变仍然具有挑战性。本研究旨在探讨头脉冲眼球震颤偏斜测试 (HINTS) 与躯干共济失调或 ABCD2 评分相结合区分 ER 内 AVS 患者中风和周围前庭疾病的能力。方法 我们前瞻性地招募了 2022 年 12 月至 2023 年 6 月期间的 121 名 AVS 患者，其中 69 名患者出现前庭神经炎（VN），其余患者出现后循环卒中（PCS）。我们分析了 HINTS 结果、躯干共济失调和 ABCD2 评分，并使用配对样本的 McNemar 检验比较了 HINTS、躯干共济失调、ABCD2 评分及其组合之间的敏感性和特异性。结果 HINTS 联合 2-3 级躯干共济失调在区分 PCS 和 VN 方面的敏感性显着高于单独的 HINTS（100% vs 88.5%，p=0.031）。 HINTS 加上 2-3 级躯干共济失调的特异性与单独 HINTS 的特异性没有显着差异 (p=0.125)；然而，ABCD2评分与HINTS的结合并没有提高诊断准确性。 ABCD2 评分 ≥4 级加 2-3 级躯干共济失调的敏感性显着高于单纯 ABCD2 评分 ≥4 或单纯 2-3 级躯干共济失调的敏感性（分别为 p=0.016 和 p<0.001），且不显着低于孤立的提示 (p=0.508)。结论 与ABCD2评分相比，躯干共济失调对HINTS鉴别PCS更有价值。尽管ABCD2评分和躯干共济失调的组合具有显着意义，但它并不能替代HINTS。可根据合理要求提供数据。当前研究中使用或分析的数据集可根据合理要求从相应作者处获得。