ArticleCureus2025
Knowledge, Attitude, and Practice of the Head Impulse, Nystagmus, and Test of Skew (HINTS) Examination Among Emergency Physicians in Saudi Arabia: A Cross-Sectional Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
Objectives We aimed to assess the knowledge, attitude, and practice levels of the head impulse, nystagmus, and test of skew (HINTS) examination by the Saudi Commission for Health Specialties registered emergency physicians and board residents in Saudi Arabia. Materials and methods This cross-sectional survey study enrolled 101 registered emergency physicians and board residents in Saudi Arabia. Participants completed a self-administered online survey evaluating their understanding, attitudes, and application of the HINTS examination, a tool to differentiate central from peripheral vertigo. Results A high proportion of participants (68/101, 67.3%) demonstrated a satisfactory level of knowledge, exhibited a favorable attitude (59/101, 58.4%), and engaged in good practice (82/101, 81.2%). However, the majority of physicians expressed disagreement with the use of the HINTS examination to differentiate between central and peripheral vertigo. The HINTS examination is underutilized by most emergency physicians (56/101, 55.4%) and during consultations (47/101, 46.5%). There was a statistically significant association between position, certifications, and knowledge (p=0.017, 0.028), while certification was the sole statistically significant predictor of attitude (p=0.004). Conclusions Physicians with less than five years of experience, particularly those in training or holding the Saudi Board of Emergency Medicine certification, demonstrated stronger knowledge, more favorable attitudes, and greater utilization of the HINTS examination. Identified gaps in the exam's perceived sensitivity, appropriate use, and physicians' confidence highlight the need for additional educational interventions to promote effective implementation in emergency settings.
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