# 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

## TL;DR

This study evaluates how well emergency physicians in Saudi Arabia know and use the HINTS exam to diagnose vertigo, finding gaps in its adoption and suggesting a need for more training.

## Contribution

The study identifies knowledge and practice gaps in using the HINTS exam among Saudi emergency physicians and links these to experience and certification.

## Key findings

- Most participants showed satisfactory knowledge of the HINTS exam but underutilized it in practice.
- Certification was a significant predictor of favorable attitudes toward the HINTS exam.
- Physicians with less than five years of experience and board certification demonstrated better knowledge and practice.

## 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.