Long-term predictive validity of the Pediatric Pain Screening Tool for chronic postsurgical pain and pain-related quality of life impairment: associations with risk stratification groups in Spain.

Abstract

Chronic postsurgical pain (CPSP) and pain-related quality of life impairment are prevalent in pediatric populations. The Pediatric Pain Screening Tool (PPST) offers early risk stratification, yet its long-term predictive validity remains underexplored. This longitudinal study aimed to (1) assess the predictive validity of the PPST for CPSP and pain-related impairment over 24 months, (2) evaluate the validity of the associations between clinical and psychological variables and PPST risk classification levels to test underlying hypotheses, and (3) examine convergent validity through correlations between PPST total scores and related clinical and psychological domains. Participants undergoing surgery (8–17 years) completed baseline questionnaires assessing CPSP and pain-related quality of life impairment, with follow-ups at 3, 6, 12, and 24 months. Additionally, PPST cut-off scores, discriminant, predictive and convergent validity, as well as predictors of high-risk classification in the PPST, were analyzed. A total of 159 children (mean age: 12.4 years; 37.1% female) were included. The PPST showed strong predictive validity for CPSP and pain-related quality of life impairment at all time points, with sensitivity, specificity, and AUC values above .80. Psychosocial and physical subscales showed strong concurrent validity, effectively distinguishing low-, medium-, and high-risk groups. The PPST correlated moderately to strongly with pain intensity, catastrophizing, anxiety, fear of pain, pain interference, and quality of life. High-risk participants had significantly worse scores across these variables, with catastrophizing being a key predictor. The PPST showed strong long-term predictive validity, reliable risk stratification, and robust psychometric performance in a Spanish pediatric population.