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A prospective, observational validation of HRAD±, a novel pediatric affect and cooperation scale
Romy Yun1, Daniel Qian2, Ellen Wang1
1Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, United States of America.
Insights
The HRAD± scale effectively assesses pediatric patient affect and cooperation during anesthesia mask induction. It shows strong correlations with other established scales, proving its clinical utility.
Area of Science:
- Pediatric Anesthesiology
- Patient Monitoring
- Behavioral Assessment
Background:
- Assessing pediatric patient affect and cooperation during anesthesia induction is crucial for safe and effective care.
- Existing assessment tools may lack simplicity or broad applicability in the perioperative setting.
Purpose of the Study:
- To evaluate the clinical utility of the HRAD± (Happy, Relaxed, Anxious, Distressed) scale for assessing pediatric affect and cooperation during inhalational mask induction.
- To examine the inter-rater reliability (IRR) and predictive validity of the HRAD± scale.
Main Methods:
- A prospective observational study involving 197 children aged 1-14 years undergoing inhalational mask anesthesia.
- Two independent research assistants (RAs) utilized HRAD±, mYPAS, OSBD, and ICC to score patient affect and cooperation during induction.
- Inter-rater reliability of HRAD± was assessed, and its correlation with other scales and emergence delirium (PAED, Watcha, Cravero) was analyzed.
Main Results:
- HRAD± scores demonstrated strong correlations with the modified Yale Preoperative Anxiety Scale (mYPAS) (r=0.840) and moderate correlations with the Observation Scale of Behavioral Distress (OSBD) and Induction Compliance Checklist (ICC).
- Inter-rater reliability for affect and cooperation using HRAD± was moderate (κ=0.595 and κ=0.478, respectively).
- Weak correlation was found between HRAD± and the Pediatric Anesthesia Emergence Delirium (PAED) scale; no correlation was observed with the Watcha and Cravero scales.
Conclusions:
- The HRAD± scale is a clinically useful and straightforward tool for assessing pediatric affect and cooperation during inhalational mask induction.
- HRAD± scores correlate well with established research assessment scales, supporting its validity and application in clinical practice.
Study Objective:
HRAD± was developed to quickly assess pediatric perioperative affect and cooperation. HRAD± represents: Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperativity. The primary aim of this study was to investigate the clinical utility of HRAD± as an affect and cooperation assessment tool for inhalational mask induction. Secondary aims examined inter-rater reliability (IRR) of HRAD± and predictive validity of induction HRAD± with emergence delirium.
Design:
This was a prospective observational investigation.
Setting:
We conducted this investigation at Lucile Packard Children's Hospital Stanford, an academic, quaternary care children's hospital in Northern California.
Patients:
A total of 197 patients were included in this investigation. Children 1-14 years of age, who underwent daytime procedures with inhalational induction of anesthesia and American Society of Anesthesiologists physical status I-III were eligible.
Interventions:
During mask induction, two trained research assistants (RAs) independently scored the patient's affect and cooperation. After extubation, the same investigators observed the patient's emergence.
Measurements:
RAs scored each mask induction using the following scales: HRAD±, modified Yale Preoperative Anxiety Scale (mYPAS), Observation Scale of Behavioral Distress (OSBD), and Induction Compliance Checklist (ICC). Correlations were calculated to HRAD±. IRR of HRAD± between the RAs as well as predictive validity of HRAD± to Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales were calculated.
Main Results:
HRAD± scores strongly correlated with mYPAS (r = 0.840, p < 0.0001) with moderate correlation to OSBD (r = 0.685, p < 0.0001) and ICC (-0.663, p < 0.0001). IRR was moderate for the affect and cooperation portion of the HRAD± scale, respectively (κ = 0.595 [p < 0.0001], κ = 0.478 [p < 0.0001]). A weak correlation was observed with PAED (r = 0.134 [p = 0.0597]) vs HRAD±. No correlations were observed between Watcha (r = 0.013 [p = 0.8559]) and Cravero and HRAD± scales (r = 0.002 [p = 0.9767]).
Conclusions:
HRAD± is a clinically useful and simple scale for evaluating pediatric affect and cooperation during inhalational mask induction. Results demonstrate correlation with commonly utilized research assessment scales.
