How Good Are We in Evaluating a Bedside Head Impulse Test?
Athanasia Korda, John Patrick Carey, Ewa Zamaro and 2 others
PMID 33136647WHAT IT FOUND
An expert missed most corrective saccades during bedside head impulse tests.
Sensitivity was 20.7%, but specificity was 100%. Saccade amplitude, not latency or gain, predicted detection. Each 1° increase nearly doubled the odds of spotting a saccade.
Key findings
01The expert physician had a low overall sensitivity (20.7%) for identifying saccades, but perfect specificity (100%).
02Saccade amplitude was the most significant predictor of detection; an increase of one degree nearly doubled the probability of the physician identifying a saccade.
03VOR gain and saccade latency played a minor or non-significant role in the physician's ability to detect the saccade.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study involved only seven patients, limiting generalizability. Only one expert examiner was tested, so findings do not apply to novices or other clinicians. The examiner knew the patients' medical history, which could have influenced their interpretation. Many tests were excluded due to artifacts, reducing the available data.
Declared interests
Research Support, Non-U.S. Gov't.
The easy way to misread this
Do not conclude that bedside head impulse testing is useless. The physician never falsely identified a saccade (100% specificity), so a positive bedside test is highly reliable evidence of vestibular dysfunction, even though a negative test often misses it.