Assessing Correlations Between PROMIS-25 and QuickDASH in Pediatric Patients With Upper Extremity Trauma.

Abstract

Background: In pediatric upper extremity (UE) trauma, outcome tracking is essential to guide treatment decisions. QuickDASH is commonly used as a region-specific outcome measure but is limited in scope and comparability across populations. PROMIS-25 is a standardized multidomain tool assessing physical function, pain, fatigue, emotional health, and social relationships. Its relationship with QuickDASH in pediatric UE trauma remains unclear. This study aimed to assess correlations between PROMIS-25 domains and QuickDASH scores and explored variation across demographic subgroups and perioperative timing.

Methods: This IRB-approved retrospective study was conducted at a single tertiary pediatric trauma center. Pediatric patients with UE injuries were included if they completed paired PROMIS-25 and QuickDASH questionnaires. A total of 591 paired survey instances were analyzed. Spearman correlation coefficients were utilized to assess the associations between PROMIS-25 domains and QuickDASH scores. Floor and ceiling effects were quantified. Rho-to-Z transformations were performed to assess differences in correlation strength across sex, age, race/ethnicity, and operative timing.

Results: QuickDASH scores correlated strongly with PROMIS-25 functional mobility ( ρ =-0.84, P <0.01) and PROMIS Pediatric Upper Extremity Short Form ( ρ =-0.87, P <0.01) and showed a strong-moderate correlation with pain interference ( ρ =0.64, P <0.01). Fatigue ( ρ =0.54), depression ( ρ =0.51), and anxiety ( ρ =0.43) demonstrated moderate correlations, while peer relationships showed a weak association ( ρ =-0.15; all P <0.01). QuickDASH demonstrated a substantial floor effect (28.3%) with minimal ceiling effect, whereas PROMIS functional mobility and pediatric UE-SF showed notable ceiling effects (42.5% and 39.6%) with negligible floor effects. Correlations varied by sex, age, and operative status.

Conclusion: PROMIS-25 demonstrates strong concurrent validity with QuickDASH in pediatric UE trauma, particularly for physical function and pain domains. Given the differing ceiling and floor effects observed across instruments, PROMIS-25 may be especially useful for postoperative assessment, while QuickDASH may provide complementary information in higher-functioning patients.

Levels of evidence: Level III.