Avaliação do teste de impulso cefálico clínico (HIT-c) realizado por examinadores com diferentes níveis de experiência

Abstract

Introduction: The Clinical Head Impulse Test (c-HIT) identifies the vestibular function and uses that information to help diferentiating pathologies of central origin from those of peripheral origin in the emergency room. However, this test is underused due to the difficulty of interpretation. Objective: Express the current level of experience of the examiners in carrying out the c-HIT and using the findings to make the exam (examinor’s dependente) more acurate. Methodology: This is an accurate, prospective, double-blind study for examiners and patients, for which a data collection form was prepared, containing the evaluation for c-HIT for the three levels of examiners and the comparation with the results of the Video Head Impulse Test (v-HIT). Patients who failed to perform the test or did not accept to participate the research were excluded. Results: Fifty-seven patients met the inclusion and exclusion criteria. Thirtyeight participants (66.8%) were female and nineteen male (33.3%). The primary diagnosis was of Menière’s diseas with fourteen patients. There was significant agreement between the diferent levels of examiners, with a weak agreement (kappa between 0 and 0.2) between residentes level 1 and 2. And a slight agreement (kappa between 0.2 and 0.4) between level 3 and levels 1 and 2. There was a decrease in sensitivity (level 1 and 2: 86,7% and level 3: 60%), na increase in specificity (level 1: 57.1%, level 2: 78.6% and level 3 : 81%) and increased accuracy (level 1: 64.9%, level 2: 80.7 %% and level 3: 75.4%). Conclusion: It was concluded that the level of experience directly influences the interpretation of the HIT-c result. Accuracy was low for the level 1 examiner, increased for level 2 examiner and remained high for the level 3 examiner. In addition, the sensitivity was inversely proportional to the examiner’s level of experience and the specificity was directly proporcional.