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PEDIATRIC ANESTHESIOLOGY

Prediction of Preoperative Anxiety in Children: Who Is Most Accurate?

Jill E. MacLaren, PhD^*, Caitlin Thompson, BA^¶, Megan Weinberg, MA^¶, Michelle A. Fortier, PhD^*, Debra E. Morrison, MD, Danielle Perret, MD, and Zeev N. Kain, MD, MBA^*

From the *Center for the Advancement of Perioperative Health, University of California, Irvine, California; Department of Anesthesiology and Perioperative Care, University of California, Irvine, California; Department of Pediatric Psychology, Children’s Hospital Orange County, Orange, California; and Departments of Child Psychiatry and ¶Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.

Address correspondence and reprint requests to Zeev N. Kain, MD, MBA, Department of Anesthesiology at University of California, Irvine, 333 City Blvd W, Orange, CA 92868. Address e-mail to zkain{at}uci.edu.

Abstract

BACKGROUND: In this investigation, we sought to assess the ability of pediatric attending anesthesiologists, resident anesthesiologists, and mothers to predict anxiety during induction of anesthesia in 2 to 16-yr-old children (n = 125).

METHODS: Anesthesiologists and mothers provided predictions using a visual analog scale and children’s anxiety was assessed using a valid behavior observation tool the Modified Yale Preoperative Anxiety Scale. All mothers were present during anesthetic induction and no child received sedative premedication. Correlational analyses were conducted.

RESULTS: A total of 125 children aged 2–16 yr, their mothers, and their attending pediatric anesthesiologists and resident anesthesiologists were studied. Correlational analyses revealed significant associations between attending predictions and child anxiety at induction (r_s = 0.38, P < 0.001). Resident anesthesiologist and mother predictions were not significantly related to children’s anxiety during induction (r_s = 0.01 and 0.001, respectively). In terms of accuracy of prediction, 47.2% of predictions made by attending anesthesiologists were within one standard deviation of the observed anxiety exhibited by the child, and 70.4% of predictions were within two standard deviations.

CONCLUSIONS: We conclude that attending anesthesiologists who practice in pediatric settings are better than mothers in predicting the anxiety of children during induction of anesthesia. Although this finding has significant clinical implications, it is unclear if it can be extended to attending anesthesiologists whose practice is not mostly pediatric anesthesia.