Development and validation of an intraoperative hypothermia risk assessment scale for school-aged children

Intraoperative hypothermia (core temperature <36 °C) is a common and detrimental complication in pediatric surgery. School-aged children (6-12 years) possess unique physiological vulnerabilities, yet a validated, age-specific risk assessment tool is lacking, leading to potential gaps in targeted prevention.

To develop and preliminarily validate a specialized intraoperative hypothermia risk assessment scale for school-aged children undergoing surgery.

This prospective scale development and validation study had three phases. First, a literature review defined the initial item pool. Second, a two-round Delphi consultation with 16 pediatric surgery experts (authority coefficients: 0.875, 0.900) refined items and confirmed content validity. The Delphi method was chosen for early-phase tool development to achieve clinical face and content validity via expert consensus, with equal item weighting as a starting point for future optimization. Finally, from July to December 2024, the scale was used on 398 school-aged surgical patients at a tertiary children's hospital. Intraoperative nasopharyngeal temperature monitoring was the reference for hypothermia (core temperature <36 °C after anesthesia induction). Scale reliability was measured by Cronbach's α, and predictive validity was evaluated with ROC curve analysis.

The final scale consists of 13 items across two domains: patient-related factors (4 items) and iatrogenic/procedural factors (9 items). Each item is scored 1-3, yielding a total score range of 13-39, with higher scores indicating greater risk. In the validation cohort of 398 patients (211 males, 187 females; mean age 8.4 ± 2.1 years), the incidence of intraoperative hypothermia was 47.2% (188/398). Baseline characteristics revealed mean BMI 16.8 ± 3.2 kg/m², 62.3% undergoing general anesthesia, and mean surgical duration 2.1 ± 1.4 h. The scale demonstrated acceptable internal consistency (Cronbach's α = 0.731). The ROC analysis revealed an Area Under the Curve (AUC) of 0.743 (95% CI: 0.692-0.794, P < 0.001), indicating fair discriminative ability. The optimal cut-off score was 28, achieving a sensitivity of 0.752 and a specificity of 0.640 for predicting hypothermia.

We developed a novel, reliable, and valid risk assessment scale for intraoperative hypothermia in school-aged children. This tool enables risk stratification using preoperatively available information to facilitate individualized warming strategies and potentially improve perioperative outcomes. Further multi-center validation is warranted to confirm its generalizability.