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A prospective, observational study of a pediatric affect and cooperation scale (HRAD±) for vascular access procedures
Romy Yun1, Kristin M Kennedy2, Janet Titzler3
1Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pediatric Anesthesiology, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA.
Insights
The Happy, Relaxed, Anxious, Distressed (HRAD±) scale effectively assesses pediatric procedural anxiety and cooperation during vascular access. This efficient tool correlates well with established scales, aiding clinical decisions and interventions.
Area of Science:
- Pediatric Medicine
- Psychology
- Clinical Assessment
Background:
- Pediatric procedural anxiety is prevalent, particularly during vascular access.
- Existing anxiety scales (OSBD-r, mYPAS, mICC) are often too complex for routine clinical use.
- The HRAD± scale offers a clinically efficient observational method for assessing pediatric procedural affect and cooperation.
Purpose of the Study:
- To evaluate the clinical utility of the HRAD± scale in pediatric patients undergoing vascular access procedures.
- To determine the correlation between HRAD± scores and established research-based anxiety and cooperation scales.
- To assess the inter-rater reliability of the HRAD± scale among observers.
Main Methods:
- A prospective, observational study was conducted with pediatric inpatients (1 month to 25 years) undergoing peripheral IV insertion or phlebotomy.
- Two research assistants independently used HRAD±, OSBD-r, mYPAS, and mICC to score patients during procedures.
- Correlation analyses and Fleiss' Kappa were used to assess scale associations and inter-rater reliability.
Main Results:
- HRAD± scores showed strong correlations with the Observation Scale of Behavioral Distress-Revised (OSBD-r) and the modified Yale Preoperative Anxiety Scale (mYPAS) (p < 0.0001).
- The cooperation component of HRAD± strongly correlated with the modified Induction Compliance Checklist (mICC) (p < 0.0001).
- Moderate inter-rater reliability was observed for HRAD± between research assistants and healthcare providers (p < 0.0001).
Conclusions:
- The HRAD± scale demonstrates strong validity and reliability for assessing pediatric procedural anxiety and cooperation.
- HRAD± is a practical tool for rapid clinical assessment during vascular access, supporting informed decision-making.
- Wider adoption of HRAD± can help guide targeted interventions to reduce anxiety in pediatric patients.
Background:
Anxiety is common in pediatric patients, especially during vascular access procedures. Most well-studied affect and anxiety scales, including the Observation Scale of Behavioral Distress-Revised (OSBD-r), the modified Yale Preoperative Anxiety Scale (mYPAS), and the modified Induction Compliance Checklist (mICC), are too cumbersome for clinical use outside of research settings. HRAD± (Happy, Relaxed, Anxious, Distressed with yes/no to cooperation) is a clinically-efficient observational scale that evaluates pediatric procedural affect and cooperation. This study examined the clinical utility of HRAD± during vascular access procedures in children. The aims were to investigate the correlation of HRAD± to highly reliable, research-based affect and cooperation scales and to assess inter-rater reliability (IRR) between observers in this setting.
Methods:
This was a prospective, observational study conducted at Lucile Packard Children's Hospital Stanford. Inpatient participants were 1 month to 25 years old and undergoing a peripheral intravenous insertion or phlebotomy. Two trained research assistants (RAs) scored each patient independently during the vascular access procedure using HRAD±, OSBD-r, mYPAS, and mICC. Correlation analyses computed the associations between HRAD± and reference scales. IRR between RAs and vascular access providers was calculated using Fleiss' Kappa.
Results:
A total of 234 patients were included. HRAD± scores strongly correlated with OSBD-r and mYPAS (p < 0.0001, p < 0.0001, respectively). The cooperation assessment of HRAD± demonstrated strong correlation to mICC (p < 0.0001). IRR of HRAD± between research assistants and vascular access providers showed moderate agreement (p < 0.0001).
Conclusion:
HRAD± demonstrated strong correlation to the reference affect and cooperation scales. This study supports the utility of HRAD± for rapid assessment of pediatric procedural anxiety and cooperation during vascular access procedures. HRAD± can serve as a practical tool for facilitating clinical decisions, and its wider incorporation into healthcare settings would importantly guide targeted interventions to reduce patient anxiety.
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