From prediction to action: developing a risk-stratified management tool for children with new-onset tic disorders.

Many children with provisional tic disorder (PTD) progress to chronic tics, but early risk stratification tools are lacking. In a prospective cohort of children with new-onset PTD, we developed a multivariable logistic regression model to predict 12-month progression to chronic tic disorders. The model was internally validated (bootstrap) and decision curve analysis was used to define risk thresholds. The final analytic cohort comprised 108 children. Three independent predictors of progression were identified: longer tic duration (adjusted odds ratio [aOR] = 1.18 per month, 95% CI: 1.01-1.38), higher parent tic questionnaire (PTQ) vocal score (aOR = 1.09 per point, 95% CI: 1.02-1.16), and presence of a comorbidity (aOR = 2.84, 95% CI: 1.01-8.02). A dual-threshold approach defined low- (< 30%), intermediate- (30-56%), and high-risk (≥ 56%) strata. The high-risk group had a 70.5% progression rate (vs. 27.3% in low-risk), a relative risk of 2.58, and a number needed to intervene of 2.3. The model was translated into a nomogram, online calculator, and risk-stratified management pathway. We provide a preliminary risk-stratified management tool that may support proactive and resource-efficient care for children with new-onset tics.