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PEDIATRIC ANESTHESIOLOGY

The Perioperative Validity of the Visual Analog Anxiety Scale in Children: A Discriminant and Useful Instrument in Routine Clinical Practice to Optimize Postoperative Pain Management

Sophie Bringuier, PharmD, PhD^*, Christophe Dadure, MD, MSc^*, Olivier Raux, MD, MSc^*, Amandine Dubois, MSc, Marie-Christine Picot, MD, PhD, and Xavier Capdevila, MD, PhD

From the *Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital; Epidemiology and Clinical Research Department, Arnaud de Villeneuve University Hospital; Developmental Psychology Department, Montpellier III University; and Department of Anesthesiology and Critical Care Medicine, University Montpellier 1 and Lapeyronie University Hospital, Montpellier, France.

Address correspondence and reprint requests to Sophie Bringuier, PharmD, PhD, Department of Anesthesiology, Acute Pain and Critical Care Medicine, Lapeyronie University Hospital, Avenue du Doyen G Giraud, Montpellier 34925, France. Address e-mail to s-bringuierbranchereau{at}chu-montpellier.fr.

Abstract

BACKGROUND: Because children’s anxiety influences pain perception, perioperative anxiety should be evaluated in clinical practice with a unique, useful, and valid tool to optimize pain management. In this study, we evaluated psychometric properties of the visual analog scale (VAS)-anxiety for children and to study its perioperative relevance in clinical practice.

METHODS: One hundred children scheduled for elective surgery and general anesthesia were included. VAS-anxiety was measured at four timepoints and compared with both versions of State Spielbergers’ questionnaires (State-Trait Anxiety Inventory for Youth [STAIY] and State-Trait Anxiety Inventory for Children [STAIC]) and the modified Yale Preoperative Anxiety Scale. Children’s pain, parents’ anxiety, and parents’ proxy report of children’s anxiety were evaluated using VAS.

RESULTS: The correlation between STAIC and VAS-anxiety was significant on the day of discharge. Moreover, changes over time were not significant with STAIC, whereas VAS-anxiety was significantly sensitive to changes over time in the two groups of age (7–11 yr and 12–16 yr). A receiver operating characteristic curve, using modified Yale Preoperative Anxiety Scale as reference, determined a VAS-anxiety cutoff at 30 to identify high-anxiety groups. Pain levels were significantly higher when children were anxious (VAS 30) in the postoperative period. Moreover, children’s anxiety and pain were higher when parents were anxious.

CONCLUSION: VAS-anxiety is a useful and valid tool to assess perioperative anxiety in children aged 7–16 yr. The influence of children’s and parents’ anxiety on children’s postoperative pain suggests that VAS-anxiety should be recommended routinely for postoperative clinical practice to optimize anxiety and pain management.