Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi, South Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.
Sci Rep. 2021 Apr 8;11(1):7750. doi: 10.1038/s41598-021-87412-7.
Reversible cerebral vasoconstriction syndrome (RCVS) is one of the most important differential diagnosis in patients with thunderclap headache (TCH). We aimed to develop a new scoring system for RCVS in patients with TCH. We retrospectively analyzed 72 patients enrolled in the prospective study of TCH conducted in 2015-2016 (derivation set). We identified possible predictors for the diagnosis of RCVS and constructed a prediction model (RCVS-TCH score) using the multivariable logistic regression model. Diagnostic performance was validated to an independent validation set from our headache registry. The derivation set comprised 41 patients with RCVS and 31 with non-RCVS, and the validation set included 253 patients with TCH (165 with RCVS and 88 with non-RCVS). The RCVS-TCH score (range: 0-12) contained four predictors: recurrent TCHs, female sex, triggering factor for TCH (single or multi) and blood pressure surge. The C-index of RCVS-TCH score was 0.929 (95% CI = 0.874-0.984). The RCVS-TCH score ≥ 7 had a sensitivity of 80% and a specificity of 97% in discriminating RCVS from non-RCVS. In the validation set, RCVS-TCH score showed a C-index of 0.861 (95% CI = 0.815-0.908). In our study, the RCVS-TCH showed good performance, which may aid the diagnosis of RCVS among patients with TCH.
可逆性脑血管收缩综合征（RCVS）是闪电样头痛（TCH）患者最重要的鉴别诊断之一。我们旨在为 TCH 患者建立 RCVS 的新评分系统。我们回顾性分析了 2015-2016 年进行的 TCH 前瞻性研究中纳入的 72 例患者（推导集）。我们确定了可能有助于 RCVS 诊断的预测因素，并使用多变量逻辑回归模型构建了预测模型（RCVS-TCH 评分）。诊断性能在我们头痛登记处的独立验证集中得到验证。推导集包括 41 例 RCVS 患者和 31 例非 RCVS 患者，验证集包括 253 例 TCH 患者（165 例 RCVS 和 88 例非 RCVS）。RCVS-TCH 评分（范围：0-12）包含四个预测因素：复发性 TCH、女性、TCH 的触发因素（单发或多发）和血压波动。RCVS-TCH 评分的 C 指数为 0.929（95%CI=0.874-0.984）。RCVS-TCH 评分≥7 时，区分 RCVS 和非 RCVS 的敏感性为 80%，特异性为 97%。在验证集中，RCVS-TCH 评分的 C 指数为 0.861（95%CI=0.815-0.908）。在我们的研究中，RCVS-TCH 表现出良好的性能，这可能有助于 TCH 患者 RCVS 的诊断。
