The assessment of preoperative anxiety in children has been challenging due to the lack of a reliable measurement tool. Previous research led to the development of the Yale Preoperative Anxiety Scale (YPAS) for evaluating anxiety during anesthesia induction. This study aimed to modify the YPAS for use in the preoperative holding area, creating the modified Yale Preoperative Anxiety Scale (m-YPAS), and validate it against the established State-Trait Anxiety Inventory for Children (STAIC).
Researchers analyzed video recordings of children in a preoperative holding area. The original five categories of the YPAS effectively captured most observed behaviors. However, modifications were made to address newly observed behaviors. Inter-observer reliability, measured using weighted kappa statistics, ranged from 0.68 to 0.86, demonstrating substantial agreement. Intra-observer reliability was similarly high, with weighted kappa ranging from 0.63 to 0.90.
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A significant correlation (P = 0.01, r = 0.79) between the m-YPAS and the STAIC indicated acceptable concurrent validity. Construct validity was also high, evidenced by increasing m-YPAS scores as children transitioned from the holding area (28 ± 8) to the operating room (35 ± 12), and finally to mask induction (43 ± 15; F [1,36] = 0.6, P = 0.001). This progressive increase in scores supports the m-YPAS’s ability to measure anxiety levels across different perioperative stages.
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The m-YPAS demonstrated good to excellent observer reliability, along with high concurrent and construct validity. These findings suggest the m-YPAS is a suitable instrument for evaluating children’s anxiety throughout the perioperative period. The development of the m-YPAS addresses a significant gap in pediatric perioperative care, providing a statistically valid tool for assessing anxiety in this vulnerable population. This allows for more effective evaluation of interventions aimed at reducing preoperative anxiety in children. Future research can utilize the m-YPAS to compare and improve anxiety management techniques.
