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Predicting Anxiety in Children Aged 2-6 During Preoperative Anesthesia Consultation-A Prospective Observational Study
Armin Sablewski1, Charlotte Neitzel1, Maximilian Grosser1
1Department of Anesthesiology and Intensive Care Medicine, University Hospital S-H, Kiel, Germany.
Insights
Predicting preoperative anxiety in young children is challenging for both parents and anesthesiologists. Simple behavioral cues during consultation may help identify children at risk for heightened anxiety during anesthesia induction.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
Background:
- Preoperative anxiety is common in young children (2-6 years) undergoing surgery.
- This anxiety can lead to adverse outcomes.
- Anesthesiologists often rely on limited preoperative interactions to predict a child's anxiety level.
Purpose of the Study:
- To evaluate the accuracy of early anxiety predictions made by anesthesiologists and parents.
- To identify early predictors of heightened anxiety at anesthesia induction in children.
- To improve preoperative anxiety management strategies.
Main Methods:
- Prospective observational study involving 92 children aged 2-6 years.
- Anesthesiologists and parents predicted child's anxiety using visual analog scale (VAS).
- Observed anxiety measured with Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF); prediction accuracy assessed via correlation and ROC analysis.
Main Results:
- Weak correlation between predicted and observed anxiety for parents (rs=0.220) and very weak for anesthesiologists (rs=0.106).
- Predictive performance was limited for parents (AUC=0.643) and negligible for anesthesiologists (AUC=0.517).
- Positive response to a greeting ('high-five') correlated with significantly lower induction anxiety (p<0.001); younger age, migration background, and inhalational induction were associated with higher anxiety.
Conclusions:
- Preoperative anxiety prediction in children is imprecise for both parents and anesthesiologists.
- Simple behavioral cues, like a child's response to a greeting, may aid early identification of at-risk children.
- Individualized anxiety management strategies involving children and parents are recommended.
Background:
Preoperative Anxiety in Young Children Is Common and Can Lead to Adverse Outcomes. In Clinical Routine, Anesthesiologists Must Often Predict Anxiety Based on Limited Interaction.
Aims:
This study aimed to evaluate the accuracy of early anxiety predictions and to identify early predictors of heightened anxiety at anesthesia induction.
Methods:
In this prospective observational study, anesthesiologists and parents of children aged 2-6 years undergoing elective procedures were asked during the preoperative consultation to predict the child's anxiety at anesthesia induction using the visual analog scale (VAS). These predictions were compared to observed anxiety during induction, measured with the Modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Prediction accuracy was assessed using Spearman's correlation (rs) and receiver operating characteristics (ROC) analysis. Potential predictors of significant anxiety defined as a mYPAS-SF > 30 were analyzed.
Results:
A total of 92 prediction sets were analyzed. Correlation between predicted and observed anxiety was weak for parents (rs = 0.220, 95% CI 0.01-0.41) and very weak for anesthesiologists (rs = 0.106, 95% CI -0.11-0.31). Predictive performance was limited for parents (AUC = 0.643) and negligible for anesthesiologists (AUC = 0.517). Children who responded positively to a greeting ('high-five') during consultation showed significantly lower anxiety during anesthesia induction (median mYPAS-SF score 34.4 [22.9-65.1] vs. 75.0 [45.8-90.6], p < 0.001). Significant anxiety was also associated with younger age of both children and parents, migration background, and inhalational induction.
Conclusions:
Anxiety at induction remains difficult to predict during preoperative consultation. While parents performed slightly better than anesthesiologists, both lack sufficient precision. Simple behavioral cues, such as a response to a greeting, may help identify at-risk children early. Future strategies should involve children and parents in individualized anxiety management.
Trial Registration:
German Clinical Trials Registry, registration number: DRKS00035033.
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