Pediatric Pain Screening Tool: A Simple 9-Item Questionnaire Predicts Functional and Chronic Postsurgical Pain Outcomes After Major Musculoskeletal Surgeries

Abstract

Reliable, clinic-friendly screening for Chronic postsurgical pain (CPSP) risk is unavailable. Within a prospective, observational study, we evaluated Pediatric Pain Screening Tool (PPST), a concise 9-item questionnaire, as a preoperative screening tool to identify those at higher risk for CPSP (Numerical Rating Scale > 3/10 beyond 3 months post-surgery) and poor function (disability/Functional Disability Inventory [FDI]/quality of life/ Pediatric Quality of Life) after spine fusion and Nuss procedures. Incidence of CPSP was 34.86% (38/109). We confirmed PPST scale stability, test re-test reliability (ICC = 0.68; P< .001); PPST measures were positively correlated with known CPSP risk factors (P< .001) preoperative pain (Pearson or Spearman Correlation Coefficient [SCC]:0.672), Child anxiety sensitivity index (SCC:0.357), Patient Related Outcome Measures Information System pain interference (SCC:0.569), Patient Related Outcome Measures Information System depression (SCC:0.501), Pediatric Quality of Life (SCC:-0.460) and insomnia severity index (SCC0.567). Preoperative PPST and PPST physical sub-scores (median(IQR) were higher in CPSP (2[0.5,4], 1[0,2]) compared to non-CPSP (1[0,3], 0[0,1.5]) groups (P= .026, P= .029) respectively. PPST scores/sub-scores positively correlated with higher FDI at 6 months but only PPST total and PPST psychosocial subscore correlated with higher FDI at 12 months. Based on ROC, optimal PPST cutoff for CPSP was 2 (63.9% sensitivity, 64.7% specificity). CPSP risk was high (48.94% risk) if PPST ≥ 2 (n = 47) and medium (22.81%) if PPST < 2 (n = 57) after spine/pectus surgery. General and risk-strata specific, targeted psychosocial non-pharmacological interventions, need to be studied. Findings need validation in diverse, larger cohorts. CLINICALTRIALS.GOV IDENTIFIER: NCT02998138. PERSPECTIVE: The article supports Pediatric Pain Screening Tool, a simple 9-item questionnaire, as a preoperative screening tool for CPSP and function 6-12 months after spine/pectus surgeries. PPST measures correlate with known risk factors for CPSP. Risk stratification and targeted preventive interventions in high-risk subjects are proposed.

Keywords: Chronic post-surgical pain; adolescents; children; pediatric pain screening tool; questionnaire; screening.

Conflict of interest statement

Conflicts of interest: None of the authors have any conflicts of interest to disclose

Copyright © 2021. Published by Elsevier Inc.

Figures

Figure 1:

Schematic diagram representing the relationships of known risk factors and the study aims to evaluate PPST as a screening tool, its convergent validity, characteristics (reliability, variability, etc.) and the final goals including risk stratification and recommendations.

Figure 2:

Recruitment workflow diagram denoting the numbers of eligicble, approached, recruited and retained subjects. Reasons for inability to recruit and withdrawal are provided. Reasons for loss to follow up are solely due to inability to reach the subject via email, phone/mail or unwillingness to complete questionnaire despite reminders. Of 109 subjects included in overall CPSP analyses, 105 were included at 6 months and 71 at 12 months.

Figure 3.

Receiver operator characteristics (ROC) curve for CPSP prediction based on PPST total scores (Figure 3A), PPST physical subscore 1–4 risk cutoff based on functional disability index (FDI) (Figure 3B), and PPST psychosocial subscore 5–9 risk cutoff based on pediatric quality of life (PedsQL) measure (Figure 3C). Boxed numbers indicate sensitivity and specificity. Green line signifies null.

Figure 4.

CPSP risk stratification based of PPST score and suggested interventions. CPSP- Chronic postsurgical pain; PPST- pediatric pain screening tool. It is recommended to consider increased baseline risk of CPSP for female sex (compared to male) while applying this stratification.