title: The Under-Utilization of the Head Impulse Test in the Emergency Department.
abstract: BACKGROUND
  The head impulse test (HIT) is an evidenced based clinical tool to differentiate between peripheral and central causes of vertigo. Our objective was to determine the rate of utilization of the HIT in the emergency room (ER).
  
  
  METHODS
  A retrospective chart review of patients presenting to the ER over one year who received a final diagnosis of dizziness or vertigo. Details of clinical examinations, investigations, and diagnosis were recorded. Patients were grouped into episodic, acute constant, and chronic vertigo groups.
  
  
  RESULTS
  HIT was performed in only 31 of 642 (5%) patients with vertigo. In the acute constant group it was negative in 6 of 6 patients ultimately diagnosed with stroke and positive in 6 of 13 cases of peripheral vertigo.
  
  
  CONCLUSIONS
  Despite good published evidence regarding its use the HIT is under-utilized in the ER. Physicians need to be aware of the HIT and newer video HITs and make use of them in practice.
authors.affiliation: McGill University,Department of Neurology,Montreal,Quebec,Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: McDowell
authors.affiliation: McGill University,Department of Neurology,Montreal,Quebec,Canada.
authors.forename: Fraser
authors.initials: F
authors.lastname: Moore
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D064087:Head Impulse Test / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*; D015898:Tomography Scanners, X-Ray Computed; D014717:Vertigo / Q000175:diagnosis*
keywords: neurological examination; stroke; vestibular