Screening Tool to Predict Risk for Poor Outcomes in Children With Headache

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Based on answers to the PPST, participants were effectively stratified into low- (21%), medium- (31%), and high-risk (48%) groups.
Based on answers to the PPST, participants were effectively stratified into low- (21%), medium- (31%), and high-risk (48%) groups.

Use of the 9-item Pediatric Pain Screening Tool (PPST) may help clinicians identify children with headache who are at risk for poor outcomes, ultimately helping to optimize individualized therapy, according to a study published in the Journal of Pediatric Psychology.

The study included 242 pediatric patients with headache who completed the 9-item PPST and tests for pain catastrophizing, anxiety, depressive symptoms, and functional disability. Reports for functional disability in 119 patients were examined at 2-month follow-up.

According to the findings, the PPST showed discriminant validity of fair to good for detecting high emotional distress and significant disability. 

Based on answers to the PPST, participants were effectively stratified into low- (21%), medium- (31%), and high-risk (48%) groups. A greater proportion of participants who met the reference case status for emotional distress and disability were stratified into the high-risk group, which may demonstrate strong stratification ability of the PPST.

Additionally, the PPST score demonstrated fair to good discrimination of headache cases from non-headache cases, as reflected by the area under the curve for functional disability (0.74) and pain-related fear (0.88) at follow-up and baseline, respectively (P <.001).

This study had access to reports on functional disability at only 2 months, reducing the ability to determine whether the PPST provides similar longer-term value. The study did not report information about pain symptomatology, which potentially limits the overall applicability of the PPST in this cohort.

Despite these limitations, the investigators suggest the PPST “may fill a currently unmet need for providers who see young people with headache in their tertiary practice, as it provides a tool for rapidly (1-2 minutes) identifying potential risk and...informing treatment decisions.”

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Reference

Heathcote LC, Rabner J, Lebel A, Hernandez JM, Simons LE. Rapid screening of risk in pediatric headache: application of the Pediatric Pain Screening Tool [published online October 10, 2017]. J Pediatr Psychol. doi:10.1093/jpepsy/jsx123

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