Separation of stroke from vestibular neuritis using the video head impulse test: machine learning models versus expert clinicians.

Background: Acute vestibular syndrome usually represents either vestibular neuritis (VN), an innocuous viral illness, or posterior circulation stroke (PCS), a potentially life-threatening event. The video head impulse test (VHIT) is a quantitative measure of the vestibulo-ocular reflex that can distinguish between these two diagnoses. It can be rapidly performed at the bedside by any trained healthcare professional but requires interpretation by an expert clinician. We developed machine learning models to differentiate between PCS and VN using only the VHIT.

Methods: We trained machine learning classification models using unedited head- and eye-velocity data from acute VHIT performed in an Emergency Room on patients presenting with acute vestibular syndrome and whose final diagnosis was VN or PCS. The models were validated using an independent test dataset collected at a second institution. We compared the performance of the models against expert clinicians as well as a widely used VHIT metric: the gain cutoff value.

Results: The training and test datasets comprised 252 and 49 patients, respectively. In the test dataset, the best machine learning model identified VN with 87.8% (95% CI 77.6%-95.9%) accuracy. Model performance was not significantly different (p = 0.56) from that of blinded expert clinicians who achieved 85.7% accuracy (75.5%-93.9%) and was superior (p = 0.01) to that of the optimal gain cutoff value (75.5% accuracy (63.8%-85.7%)).

Conclusion: Machine learning models can effectively differentiate PCS from VN using only VHIT data, with comparable accuracy to expert clinicians. They hold promise as a tool to assist Emergency Room clinicians evaluating patients with acute vestibular syndrome.