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Published on: August 25, 2014
Development and validation of the Pediatric Anesthesia Behavior score--an objective measure of behavior during
Richard M Beringer1, Rosemary Greenwood, Nicky Kilpatrick
1Department of Paediatric Anaesthesia, Bristol Royal hospital for Children, Bristol, UK.
Insights
The new Pediatric Anesthesia Behavior (PAB) score reliably measures children's behavior during anesthesia induction. This simple tool can predict behavioral issues after surgery.
Area of Science:
- Pediatric Anesthesiology
- Behavioral Psychology
- Clinical Assessment Tools
Background:
- Objective measurement of behavioral changes in children during the perioperative period is crucial.
- Validated rating scales are needed to assess behavior during anesthesia induction.
Purpose of the Study:
- To develop and validate the Pediatric Anesthesia Behavior (PAB) score for assessing children's behavior during anesthesia induction.
- To evaluate the reliability, concurrent validity, and predictive validity of the PAB score.
Main Methods:
- A cohort of 102 healthy children (aged 2-12) undergoing general anesthesia for dental extractions was studied.
- The PAB score was measured by two independent investigators.
- Concurrent validity was assessed against the modified Yale Preoperative Anxiety Scale (m-YPAS) and Induction Compliance Checklist (ICC).
- Predictive validity was assessed against the Pediatric Anesthesia Emergence Delirium (PAED) scale and Post-Hospitalization Behavior Questionnaire (PHBQ).
Main Results:
- The PAB score showed strong correlations with the m-YPAS (P < 0.001) and ICC (P < 0.001).
- PAB score was significantly associated with the PAED scale (P = 0.031) and PHBQ (P = 0.034).
- Interobserver reliability was high, with identical scores recorded for 94% of children (Kappa = 0.886, P < 0.001).
Conclusions:
- The Pediatric Anesthesia Behavior (PAB) score is a reliable and valid tool for assessing behavior during anesthesia induction in children.
- The PAB score may help identify children at higher risk for postoperative behavioral disturbances.
Background:
Measuring perioperative behavior changes requires validated objective rating scales. We developed a simple score for children's behavior during induction of anesthesia (Pediatric Anesthesia Behavior score) and assessed its reliability, concurrent validity, and predictive validity.
Methods:
Data were collected as part of a wider observational study of perioperative behavior changes in children undergoing general anesthesia for elective dental extractions. One-hundred and two healthy children aged 2-12 were recruited. Previously validated behavioral scales were used as follows: the modified Yale Preoperative Anxiety Scale (m-YPAS); the induction compliance checklist (ICC); the Pediatric Anesthesia Emergence Delirium scale (PAED); and the Post-Hospitalization Behavior Questionnaire (PHBQ). Pediatric Anesthesia Behavior (PAB) score was independently measured by two investigators, to allow assessment of interobserver reliability. Concurrent validity was assessed by examining the correlation between the PAB score, the m-YPAS, and the ICC. Predictive validity was assessed by examining the association between the PAB score, the PAED scale, and the PHBQ.
Results:
The PAB score correlated strongly with both the m-YPAS (P < 0.001) and the ICC (P < 0.001). PAB score was significantly associated with the PAED score (P = 0.031) and with the PHBQ (P = 0.034). Two independent investigators recorded identical PAB scores for 94% of children and overall, there was close agreement between scores (Kappa coefficient of 0.886 [P < 0.001]).
Conclusion:
The PAB score is simple to use and may predict which children are at increased risk of developing postoperative behavioral disturbance. This study provides evidence for its reliability and validity.
