Comparison of Video Head Impulse Test and Bedside Head Impulse Test in Patients of Dizziness: A Cross-sectional Study

Abstract Introduction: Disorders of balance usually present as dizziness or unsteadiness in outpatient departments (OPDs). Bedside head impulse test (bHIT) is a simple way of diagnosing deficient vestibulo-ocular reflex (VOR). The primary objective of this study is to ascertain the diagnostic accuracy of bHIT in detecting VOR deficit while taking the video head impulse test (vHIT) as the gold standard. Materials and Methods: Two hundred and sixty patients were included in the study conducted for 18 months. Each study patient underwent bHIT and vHIT and the results of both tests were analyzed to derive true positive, false positive, true negative, and false negative cases, thereby extracting the sensitivity and specificity of bHIT. Effect size measures were done using Cohen’s Kappa to check the level of agreement between the tests. Results: The bHIT had a diagnostic accuracy of 74% with sensitivity of 57%, specificity of 89%, positive predictive value (PPV) at 84%, and negative predictive value (NPV) at 68%. Cohen’s Kappa was 0.468 and with P < 0.001 suggesting a moderate agreement between bHIT and vHIT. Diagnostic accuracy of bHIT increased to 75.4% for patients who were diagnosed to have a peripheral cause of giddiness with a sensitivity of 63%, specificity of 87.4%, PPV at 82.9%, and NPV at 70.9%. Cohen’s Kappa was 0.506 and with P < 0.001 and the agreement was statistically significant. Conclusion: vHIT is an integral part of Vertigo Clinics in most of the tertiary care centers. However, bHIT is a simple, cost-effective screening test with comparable diagnostic accuracy to vHIT. It can be employed in OPDs for screening patients with dizziness, thereby helping to differentiate a peripheral cause of vertigo from a central pathology.