Evaluating the Diagnostic Accuracy of the Head-Impulse Test: A Scoping Review

Leif Erik Walther, Jan Löhler, Yuri Agrawal, Edith Motschall, Fabian Schubach, Jörg J. Meerpohl, Christine Schmucker

Research output: Contribution to journalReview article

Abstract

Importance: Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed. Objective: To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms. Evidence Review: In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018. Findings: We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0% and 100% (median, 41%), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56% and 100% (median, 94%). Conclusions and Relevance: Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.

Original languageEnglish (US)
JournalJAMA Otolaryngology - Head and Neck Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Head Impulse Test
Routine Diagnostic Tests
Bibliographic Databases
Patient Advocacy
Sensitivity and Specificity
Diagnostic Errors
Libraries
Reflex
Medicine
Guidelines

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Evaluating the Diagnostic Accuracy of the Head-Impulse Test : A Scoping Review. / Walther, Leif Erik; Löhler, Jan; Agrawal, Yuri; Motschall, Edith; Schubach, Fabian; Meerpohl, Jörg J.; Schmucker, Christine.

In: JAMA Otolaryngology - Head and Neck Surgery, 01.01.2019.

Research output: Contribution to journalReview article

Walther, Leif Erik ; Löhler, Jan ; Agrawal, Yuri ; Motschall, Edith ; Schubach, Fabian ; Meerpohl, Jörg J. ; Schmucker, Christine. / Evaluating the Diagnostic Accuracy of the Head-Impulse Test : A Scoping Review. In: JAMA Otolaryngology - Head and Neck Surgery. 2019.
@article{a265e2d4e0a749b39d1713620b96959b,
title = "Evaluating the Diagnostic Accuracy of the Head-Impulse Test: A Scoping Review",
abstract = "Importance: Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed. Objective: To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms. Evidence Review: In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018. Findings: We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0{\%} and 100{\%} (median, 41{\%}), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56{\%} and 100{\%} (median, 94{\%}). Conclusions and Relevance: Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.",
author = "Walther, {Leif Erik} and Jan L{\"o}hler and Yuri Agrawal and Edith Motschall and Fabian Schubach and Meerpohl, {J{\"o}rg J.} and Christine Schmucker",
year = "2019",
month = "1",
day = "1",
doi = "10.1001/jamaoto.2019.0243",
language = "English (US)",
journal = "Archives of Otolaryngology",
issn = "2168-6181",
publisher = "American Medical Association",

}

TY - JOUR

T1 - Evaluating the Diagnostic Accuracy of the Head-Impulse Test

T2 - A Scoping Review

AU - Walther, Leif Erik

AU - Löhler, Jan

AU - Agrawal, Yuri

AU - Motschall, Edith

AU - Schubach, Fabian

AU - Meerpohl, Jörg J.

AU - Schmucker, Christine

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed. Objective: To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms. Evidence Review: In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018. Findings: We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0% and 100% (median, 41%), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56% and 100% (median, 94%). Conclusions and Relevance: Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.

AB - Importance: Vestibular symptoms rank among the most common complaints in medicine worldwide. Underlying disorders manifested by these symptoms are generally associated with an impairment of the vestibular-ocular reflex and can be assessed with different diagnostic procedures. In recent years, an increasing number of diagnostic test accuracy studies comparing various head-impulse test (HIT) methods with other diagnostic procedures have been published but not systematically reviewed. Objective: To conduct a scoping review and describe key characteristics of the growing number of diagnostic studies in patients presenting with vestibular symptoms. Evidence Review: In April 2017, published studies were identified through searches of 4 bibliographic databases: Medline, Science Citation Index Expanded, the Cochrane Library, and ScienceDirect. Studies were included if they provided diagnostic accuracy data (sensitivity and specificity) for any HIT method with reference to any other vestibular test or clinical diagnosis in patients with vestibular symptoms. Study key characteristics were extracted, and the current literature was described narratively. All analysis took place between June 2017 and July 2018. Findings: We identified a total of 27 diagnostic studies (including 3821 participants). There were disagreements between diagnostic test accuracy data both within and between studies when different HIT methods were compared with other diagnostic procedures. The proportion of correctly identified people having the disease (sensitivity) ranged between 0% and 100% (median, 41%), whereas the proportion of correctly identified people without the disease (specificity) was higher and ranged between 56% and 100% (median, 94%). Conclusions and Relevance: Based on the studies included in this review, sensitivity, specificity, and, more importantly, the risk of misdiagnosis and associated undertreatment or overtreatment cannot be reliably estimated by HIT methods for patients with vestibular symptoms. We recommend that further diagnostic studies consider (1) multiple possible underlying causes of vestibular symptoms and multiple test thresholds, (2) a representative sample of patients with and without the disease, and (3) reporting guidelines for diagnostic test accuracy studies.

UR - http://www.scopus.com/inward/record.url?scp=85065322524&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065322524&partnerID=8YFLogxK

U2 - 10.1001/jamaoto.2019.0243

DO - 10.1001/jamaoto.2019.0243

M3 - Review article

C2 - 31021380

AN - SCOPUS:85065322524

JO - Archives of Otolaryngology

JF - Archives of Otolaryngology

SN - 2168-6181

ER -