Systematic Review and Meta-Analysis of the Diagnostic Accuracy of a Graded Gait and Truncal Instability Rating in Acutely Dizzy and Ataxic Patients.

IF 2.7 3区医学 Q3 NEUROSCIENCES Cerebellum Pub Date : 2024-12-01 Epub Date: 2024-07-11 DOI:10.1007/s12311-024-01718-6

Carlos Martinez, Zheyu Wang, Guillermo Zalazar, Sergio Carmona, Jorge Kattah, Alexander Andrea Tarnutzer

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Abstract

Background: In patients presenting with acute prolonged vertigo and/or gait imbalance, the HINTS [Head-Impulse, Nystagmus, Test-of-Skew] are very valuable. However, their application may be limited by lack of training and absence of vertigo/nystagmus. Alternatively, a graded gait/truncal-instability (GTI, grade 0-3) rating may be applied.

Methods: We performed a systematic search (MEDLINE/Embase) to identify studies reporting on the diagnostic accuracy of bedside examinations in adults with acute vestibular syndrome. Diagnostic test properties were calculated for findings using a random-effects model. Results were stratified by GTI-rating used.

Results: We identified 6515 articles and included 18 studies (n = 1025 patients). Ischemic strokes (n = 665) and acute unilateral vestibulopathy (n = 306) were most frequent. Grade 2/3 GTI had moderate sensitivity (70.8% [95% confidence-interval (CI) = 59.3-82.3%]) and specificity (82.7 [71.6-93.8%]) for predicting a central cause, whereas grade 3 GTI had a lower sensitivity (44.0% [34.3-53.7%] and higher specificity (99.1% [98.0-100.0%]). In comparison, diagnostic accuracy of HINTS (sensitivity = 96.8% [94.8-98.8%]; specificity = 97.6% [95.3-99.9%]) was higher. When combining central nystagmus-patterns and grade 2/3 GTI, sensitivity was increased to 76.4% [71.3-81.6%] and specificity to 90.3% [84.3-96.3%], however, no random effects model could be used. Sensitivity was higher in studies using the GTI rating (grade 2/3) by Lee (2006) compared to the approach by Moon (2009) (73.8% [69.0-78.0%] vs. 57.4% [49.5-64.9%], p = 0.001).

Conclusions: In comparison to HINTS, the diagnostic accuracy of GTI is inferior. When combined with central nystagmus-patterns, diagnostic accuracy could be improved based on preliminary findings. GTI can be readily applied in the ED-setting and also in patients with acute imbalance syndrome.

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对急性头晕和共济失调患者的步态和躯干不稳定性分级诊断准确性的系统回顾和荟萃分析。

背景：对于出现急性长时间眩晕和/或步态失衡的患者，HINTS（头脉冲、眼球震颤、歪斜测试）非常有价值。然而，由于缺乏训练和没有眩晕/眼震，其应用可能会受到限制。另外，还可以采用步态/截肢不稳定性分级（GTI，0-3 级）：我们进行了系统性检索（MEDLINE/Embase），以确定有关急性前庭综合征成人患者床旁检查诊断准确性的研究报告。使用随机效应模型计算了检查结果的诊断测试属性。结果按所使用的 GTI 评级进行了分层：我们确定了 6515 篇文章，并纳入了 18 项研究（n = 1025 名患者）。缺血性脑卒中（n = 665）和急性单侧前庭大腺炎（n = 306）最为常见。2/3 级 GTI 预测中枢病因的敏感性（70.8% [95% 置信区间 (CI) = 59.3-82.3%]）和特异性（82.7 [71.6-93.8%] ）适中，而 3 级 GTI 的敏感性较低（44.0% [34.3-53.7%] ，特异性较高（99.1% [98.0-100.0%] ）。相比之下，HINTS 的诊断准确性更高（灵敏度 = 96.8% [94.8-98.8%]; 特异性 = 97.6% [95.3-99.9%]）。如果将中心性眼球震颤模式和 2/3 级 GTI 结合起来，灵敏度会提高到 76.4% [71.3-81.6%] ，特异性会提高到 90.3% [84.3-96.3%]，但无法使用随机效应模型。与 Moon（2009 年）的方法相比，Lee（2006 年）采用 GTI 评级（2/3 级）的研究灵敏度更高（73.8% [69.0-78.0%] vs. 57.4% [49.5-64.9%], p = 0.001）：结论：与 HINTS 相比，GTI 的诊断准确性较低。结论：与 HINTS 相比，GTI 的诊断准确性较差。根据初步研究结果，如果与中心性眼球震颤模式相结合，诊断准确性会有所提高。GTI 可随时用于急诊室，也可用于急性失衡综合征患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cerebellum 医学-神经科学

CiteScore

6.40

自引率

14.30%

发文量

150

审稿时长

4-8 weeks

期刊介绍： Official publication of the Society for Research on the Cerebellum devoted to genetics of cerebellar ataxias, role of cerebellum in motor control and cognitive function, and amid an ageing population, diseases associated with cerebellar dysfunction. The Cerebellum is a central source for the latest developments in fundamental neurosciences including molecular and cellular biology; behavioural neurosciences and neurochemistry; genetics; fundamental and clinical neurophysiology; neurology and neuropathology; cognition and neuroimaging. The Cerebellum benefits neuroscientists in molecular and cellular biology; neurophysiologists; researchers in neurotransmission; neurologists; radiologists; paediatricians; neuropsychologists; students of neurology and psychiatry and others.