视频头脉冲试验用于卒中流程中的急性头晕：一项前瞻性初步研究。

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中文摘要

背景与目的： 头晕是急诊科（ED）常见就诊原因，但后循环卒中仅凭标准临床工具和神经影像学难以发现。定量视频头脉冲试验（vHIT）可提供前庭眼反射功能的客观床旁测量，并有助于区分急性头晕的中枢性与周围性病因。
方法： 我们开展了一项前瞻性、单中心可行性及诊断准确性研究，纳入因急性头晕进入急诊卒中流程的成人（18-90岁）。vHIT在就诊后48小时内、完成标准卒中评估后进行。两名接受前庭培训的临床医生对临床和影像学数据设盲，将vHIT分类为周围性、中枢性、不确定或质量差。参考标准（卒中 vs 非卒中）是由卒中神经科医生利用所有临床信息、非增强CT以及可获得的MRI裁定的最终诊断。对可判读的vHIT研究以及意向诊断分析计算卒中的诊断指标。
结果： 30例患者接受了vHIT；11例（36.7%）为急性缺血性卒中，19例（63.3%）为非卒中诊断。30例患者中有23例（76.7%）获得可判读的vHIT结果（中枢性或周围性模式）。总体而言，vHIT模式为中枢性19例（63.3%）、周围性4例（13.3%）、不确定3例（10.0%）、质量差4例（13.3%）。在卒中患者中，11例中有9例（81.8%）呈中枢性模式，无一例呈周围性模式。在可判读研究的主要分析中，vHIT对卒中的敏感性和阴性预测值均为100%，而特异性为28.6%，总体准确性为56.5%。在纳入所有患者的意向诊断分析中，敏感性和阴性预测值仍为100%，特异性为21.1%，准确性为50.0%。
讨论： 我们的研究结果表明，vHIT在大多数因急性头晕进入急诊卒中流程的患者中可行，并且当存在明确的周围性模式时，表现出高敏感性和阴性预测值，支持其作为辅助排除工具的潜在作用。然而，特异性较低，且近四分之一的研究为不确定或质量差，限制了其作为独立诊断试验的使用。随着进一步验证和更大规模的研究，vHIT可能有助于在没有中枢病理证据的患者中支持更有针对性地使用住院、诊断性检查和急诊卒中资源。

英文摘要

BACKGROUND AND OBJECTIVES: Dizziness is a common emergency department (ED) concern, yet posterior-circulation strokes can be difficult to detect with standard clinical tools and neuroimaging alone. Quantitative video head impulse test (vHIT) provides an objective bedside measure of vestibulo-ocular reflex function and can help differentiate central from peripheral causes of acute dizziness.
METHODS: We conducted a prospective, single-center feasibility and diagnostic-accuracy study of adults (18-90 years) presenting on an ED stroke pathway for acute dizziness. vHIT was performed within 48 hours of presentation, after completion of standard stroke evaluation. Two vestibular-trained clinicians, blinded to clinical and imaging data, classified vHIT as peripheral, central, equivocal, or poor quality. The reference standard (stroke vs nonstroke) was the final diagnosis adjudicated by stroke neurologists using all clinical information, noncontrast CT, and MRI when available. Diagnostic metrics for stroke were calculated for interpretable vHIT studies and in an intention-to-diagnose analysis.
RESULTS: Thirty patients underwent vHIT; 11 (36.7%) had acute ischemic stroke and 19 (63.3%) had nonstroke diagnoses. Interpretable vHIT results (central or peripheral pattern) were obtained in 23 of 30 patients (76.7%). Overall, vHIT patterns were central in 19 (63.3%), peripheral in 4 (13.3%), equivocal in 3 (10.0%), and poor quality in 4 (13.3%). Among strokes, 9 of 11 (81.8%) had a central pattern and none had a peripheral pattern. In the primary analysis of interpretable studies, vHIT sensitivity and negative predictive value for stroke were both 100%, while specificity was 28.6% and overall accuracy was 56.5%. In the intention-to-diagnose analysis including all patients, sensitivity and negative predictive value remained 100%, with specificity at 21.1% and accuracy at 50.0%.
DISCUSSION: Our findings suggest that vHIT was feasible in most ED stroke-pathway patients with acute dizziness and demonstrated high sensitivity and negative predictive value when a clearly peripheral pattern was present, supporting its potential role as an adjunctive rule-out tool. However, specificity was low, and nearly one-quarter of studies were equivocal or poor quality, limiting its use as a standalone diagnostic test. With further validation and larger studies, vHIT may help support more targeted use of hospital admissions, diagnostic workups, and ED stroke resources in patients without evidence of central pathology.