Mazzotta Silvia, Pavlidis Elena, Cordori Cecilia, Spagnoli Carlotta, Pini Luigi Alberto, Pisani Francesco
Child Neuropsychiatry Unit, Neuroscience Department, Parma University, Parma, Italy.
Headache Centre, Modena University, Modena, Italy.
Neuropediatrics. 2015 Aug;46(4):261-8. doi: 10.1055/s-0035-1550147. Epub 2015 May 12.
This study aims to evaluate the drawings effectiveness in childhood headache assessment.
Headache is a common cause of pain in children. Although drawings have been used in childhood to recognize psychological insights and pain perception, they were rarely used for headache characterization.
We collected drawings from 67 subjects with cephalalgia during a 22-month timeframe. The clinical diagnosis was made according to the 2nd edition of The International Headache Classification. Drawings were independently categorized as migraine or tension-type headache (TTH) by two child neuropsychiatrists blinded to the clinical data. Cohen kappa for interrater agreement, sensitivity, specificity, and positive predictive value (PPV) were calculated. Subjects were also divided into three age groups to assess the influence of age. Finally, a control group of 90 subjects was collected and K-means cluster analysis was performed.
The drawings had a sensitivity of 85.71 and 81.48%, a specificity of 81.48 and 85.71%, and a PPV of 85.71 and 81.48%, for migraine and TTH diagnosis, respectively. Drawings by the older age group showed the highest predictability degree. Finally, by mean of cluster analysis, 59 of the 67 patients were correctly classified, whereas control subjects were similarly distributed between the two clusters.
Drawings are a useful instrument for migraine and TTH differential diagnosis. Thus, we suggest their inclusion in childhood headache diagnostic assessment.
本研究旨在评估绘画在儿童头痛评估中的有效性。
头痛是儿童疼痛的常见原因。尽管绘画在儿童时期已被用于识别心理洞察和疼痛感知，但很少用于头痛特征描述。
我们在22个月的时间内收集了67名头痛患者的绘画作品。临床诊断依据《国际头痛分类》第2版进行。两名对临床数据不知情的儿童神经精神科医生将绘画作品独立分类为偏头痛或紧张型头痛（TTH）。计算评分者间一致性的Cohen kappa系数、敏感性、特异性和阳性预测值（PPV）。受试者还被分为三个年龄组以评估年龄的影响。最后，收集了90名受试者的对照组并进行K均值聚类分析。
绘画对偏头痛和TTH诊断的敏感性分别为85.71%和81.48%，特异性分别为81.48%和85.71%，PPV分别为85.71%和81.48%。年龄较大组的绘画显示出最高的预测度。最后，通过聚类分析，67例患者中有59例被正确分类，而对照组受试者在两个聚类中分布相似。
绘画是偏头痛和TTH鉴别诊断的有用工具。因此，我们建议将其纳入儿童头痛诊断评估中。
