Assessing pediatric perioperative affect: A concise review of research and clinically relevant scales

Abstract

Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long‐term postoperative complications. This concise review outlines key research and clinically‐relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research‐based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time‐consuming to complete by clinicians also providing anesthesia. Clinically‐based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically‐relevant anxiety assessment tool and appraise interventions that reduce perioperative distress.

Validity of the modified‐Distraction‐Short‐Scale and Verbal‐Numeric‐Anxiety‐Fear‐Rating‐Scale for children in a preoperative setting

“…Most existing scales assess children's negative anxiety and distress behavior or are difficult to execute in the fast-paced perioperative setting. 6,9,10 We developed a scale to evaluate children's ability to distract or distance themselves from aversive events. Distracting or distancing from a stressful event contributes to a feeling of control and coping, which may lessen the future negative impact of the event.…”

“…Most existing scales assess children's negative anxiety and distress behavior or are difficult to execute in the fast‐paced perioperative setting 6,9,10 . We developed a scale to evaluate children's ability to distract or distance themselves from aversive events.…”

“…2,5 Several instruments have been developed to evaluate anxiety in children. 1,3,6 Some are more time-consuming and are thus suitable for research context, 7 while others are shorter but focus solely on children's emotions 8 or anxiety behavior. 9,10 The modified-Yale-Preoperative-Anxiety-Scale (mYPAS) is a well-validated tool for measuring preoperative anxiety but must be completed by trained raters.…”

“…Several instruments have been developed to evaluate anxiety in children 1,3,6 . Some are more time‐consuming and are thus suitable for research context, 7 while others are shorter but focus solely on children's emotions 8 or anxiety behavior 9,10 .…”

Outcomes in pediatric anesthesia: towards a universal language

“…It is still unknown how clinically significant the occurrence of hypotension is in terms of short or long-term impact on organ function and the magnitude of this impact in different age group [27]. A review of research and clinical scales measuring pediatric perioperative affect has been published [28 ▪ ]. It shows how many tools are available to be used as end points.…”