Rapid Screening of Risk in Pediatric Headache: Application of the Pediatric Pain Screening Tool

Objective The current study examined the application of a screening tool to identify biopsychosocial risk factors and derive prognostic risk groups in children and adolescents with headache pain. Methods Youth (n = 242, 8-17 years, 75.6% female) presenting for evaluation at a tertiary pediatric headache clinic completed the nine-item Pediatric Pain Screening Tool (PPST) as well as measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. In addition, 119 patients reported on functional disability at 2-month follow-up. Results The PPST demonstrated discriminant validity that ranged from fair to good for identifying significant disability and high emotional distress. Receiver operating characteristic curve analyses indicated that established cutoff scores were appropriate for the current sample, and thus participants were classified into low-risk (21%), medium-risk (31%), and high-risk (48%) groups. Only 1-6% of patients who met reference standard case status for disability and emotional distress were classified as low risk, whereas 64-90% of patients who met reference standard case status were classified as high risk, suggesting robust stratification. Conclusions The nine-item PPST may be a useful tool for efficiently identifying young patients with headache who are at risk of poor outcomes, and effectively classifying them into risk groups that could drive stratified treatment directly targeting patient needs.