Headache Unit, Neurology Department, Hospital Clínico Universitario, Valladolid, Spain.
Emergency Department, Hospital Clínico Universitario San Carlos, Madrid, Spain.
Cephalalgia. 2022 Dec;42(14):1521-1531. doi: 10.1177/03331024221120249. Epub 2022 Aug 24.
To evaluate the diagnostic accuracy of the SNNOOP10 list in the detection of high-risk headaches.
Patients that visited the Hospital Clínico San Carlos (Madrid) emergency department due to headache that were allocated to a Manchester Triage System level between critical and urgent were prospectively included but retrospectively analysed. A researcher blind to the patients' diagnosis administered a standardised questionnaire and afterwards a neurologist blind to the questionnaire results diagnosed the patient according to the International Classification of Headache Disorders. The primary endpoint was to assess the sensitivity of the SNNOOP10 list in the detection of high-risk headaches. Secondary endpoints included the evaluation of the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of each SNNOOP10 item.
Between April 2015 and October 2021, 100 patients were included. Patients were 44 years old (inter-quartile range: 33.6-64.7) and 57% were female. We identified 37 different diagnoses. Final diagnosis was a primary headache in 33%, secondary headache in 65% and cranial neuralgia in 2%. There were 46 patients that were considered as having high-risk headache. Patients from the primary headache group were younger and more frequently female. Sensitivity of SNNOOP10 list was 100% (95% confidence interval: 90.2%-100%). The items with higher sensitivity were neurologic deficit or disfunction (75.5%), pattern change or recent onset of the headache (64.4%), onset after 50 years (64.4%). The most specific items were posttraumatic onset of headache (94.5%), neoplasm in history (89.1%) and systemic symptoms (89%). The area under the curve of the SNNOOP10 list was 0.66 (95% CI: 0.55-0.76).
The red flags from the SNNOOP10 list showed a 100% sensitivity in the detection of high-risk headache disorders.
评估 SNNOOP10 清单在检测高危头痛方面的诊断准确性。
前瞻性纳入因头痛就诊于马德里圣卡洛斯临床医院急诊科且分配至危急至紧急曼彻斯特分诊系统级别的患者，但进行回顾性分析。一位对患者诊断不知情的研究者对患者进行了标准化问卷评估，随后一位对问卷结果不知情的神经科医生根据国际头痛疾病分类对患者进行了诊断。主要终点是评估 SNNOOP10 清单检测高危头痛的敏感性。次要终点包括评估 SNNOOP10 清单每个项目的敏感性、特异性、阳性预测值、阴性预测值和曲线下面积。
2015 年 4 月至 2021 年 10 月期间，共纳入 100 例患者。患者年龄为 44 岁（四分位距：33.6-64.7），57%为女性。我们共识别出 37 种不同的诊断。原发性头痛患者占 33%，继发性头痛患者占 65%，颅神经痛患者占 2%。有 46 例患者被认为患有高危头痛。原发性头痛组的患者年龄较小，且更常为女性。SNNOOP10 清单的敏感性为 100%（95%置信区间：90.2%-100%）。敏感性较高的项目为神经功能缺损或障碍（75.5%）、头痛模式改变或近期发作（64.4%）、50 岁后发作（64.4%）。特异性最高的项目为创伤后头痛发作（94.5%）、既往有肿瘤（89.1%）和全身症状（89%）。SNNOOP10 清单的曲线下面积为 0.66（95%CI：0.55-0.76）。
SNNOOP10 清单的危险信号在检测高危头痛疾病方面具有 100%的敏感性。
