Stafstrom Carl E, Rostasy Kevin, Minster Anna
Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Floating Hospital for Children, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA.
Pediatrics. 2002 Mar;109(3):460-72. doi: 10.1542/peds.109.3.460.
To determine whether drawings can aid in the differential diagnosis of headaches in children.
Before taking any history, 226 children who were seen consecutively for the evaluation of headache were asked to draw a picture to show how their headache felt. The pictures were then scored as migraine or nonmigraine by pediatric neurologists who were blinded to the clinical history. A clinical diagnosis of headache type was determined independently by another pediatric neurologist using the usual history and examination. The diagnoses of headache type based on the pictures drawn and the clinical findings obtained were then compared to calculate the sensitivity, specificity, and predictive values of the drawings for the diagnosis of migraine.
Children produced dramatic and insightful headache drawings. Compared with the clinical diagnosis (gold standard), headache drawings had a sensitivity of 93.1%, a specificity of 82.7%, and a positive predictive value (PPV) of 87.1% for migraine. That is, drawings that contained an artistic feature consistent with migraine (eg, pounding pain, nausea/vomiting, desire to lie down, periorbital pain, photophobia, visual scotoma) predicted the clinical diagnosis of migraine in 87.1% of cases. Predictive values were also calculated for specific migraine-associated features on drawings: artistic depiction of focal neurologic signs, periorbital pain, recumbency, visual symptoms (photophobia, scotomata), or nausea/vomiting had a PPV of >90% for migraine; severe or pounding pain had a PPV of >80% for migraine. Band-like pain was not predictive of migraine (PPV of 11.1%). Features on drawings such as sadness or crying did not differentiate migraine from nonmigraine headaches.
Children's headache drawings are a simple, inexpensive aid in the diagnosis of headache type, with a very high sensitivity, specificity, and predictive value for migraine versus nonmigraine headaches. We encourage the use of drawings in the evaluation of any child with a headache, as an adjunct to the clinical history and physical examination.
确定绘画是否有助于儿童头痛的鉴别诊断。
在采集任何病史之前，连续就诊以评估头痛的226名儿童被要求画一幅图来展示他们头痛的感觉。然后，对这些图画由对临床病史不知情的儿科神经科医生评定为偏头痛或非偏头痛。另一位儿科神经科医生使用常规病史和检查独立确定头痛类型的临床诊断。然后将基于所画图画和所获临床发现的头痛类型诊断进行比较，以计算图画对偏头痛诊断的敏感性、特异性和预测值。
儿童画出了生动且有见地的头痛图画。与临床诊断（金标准）相比，头痛图画对偏头痛的敏感性为93.1%，特异性为82.7%，阳性预测值（PPV）为87.1%。也就是说，包含与偏头痛一致的艺术特征（如搏动性疼痛、恶心/呕吐、想躺下、眶周疼痛、畏光、视觉暗点）的图画在87.1%的病例中预测了偏头痛的临床诊断。还计算了图画上特定偏头痛相关特征的预测值：局灶性神经体征、眶周疼痛、卧位、视觉症状（畏光、暗点）或恶心/呕吐的艺术描绘对偏头痛的PPV>90%；严重或搏动性疼痛对偏头痛的PPV>80%。带状疼痛不能预测偏头痛（PPV为11.1%）。图画上的悲伤或哭泣等特征不能区分偏头痛和非偏头痛性头痛。
儿童头痛图画是一种简单、廉价的辅助手段，有助于诊断头痛类型，对偏头痛与非偏头痛性头痛具有非常高的敏感性、特异性和预测值。我们鼓励在评估任何头痛儿童时使用图画，作为临床病史和体格检查的辅助手段。
