An evaluation of short anxiety measures for use in the emergency department

Abstract

Background: The emergency department (ED) is a stressful environment for children. Few studies assess pediatric anxiety in the ED. "Gold standard" for measuring state-anxiety, Spielberger's State-Trait Anxiety Inventory for Children (STAI-C state), is lengthy and of limited use in this setting.

Objective: The objective was to evaluate agreement between STAI-C, Likert, and modified Yale Preoperative Anxiety Scale (m-YPAS) and determine if shorter measures may be adequate replacements for STAI-C in the ED.

Methods: This is a secondary analysis of data from a previous observational cohort study of a convenience sample of children 5-17 years old presenting to the ED. Anxiety was measured using STAI-C, Likert, and m-YPAS. Spearman correlations were used to evaluate agreement between STAI-C and the brief scales. A sub-analysis evaluated agreement between scales for children ≥9 years old to assess the impact of age.

Results: Eighty children were included. Median (IQR) STAI-C state score was 32.5 (30.0, 37.8). This represents moderate state anxiety with 30% of children exhibiting elevated state anxiety. Median (IQR) Likert score was 2.0 (1.0, 2.0). Correlation between the Likert and STAI-C was moderate (r_s = 0.51; p < 0.0001). Median (IQR) m-YPAS was 28.3 (24.2, 33.3). The m-YPAS and STAI-C were unrelated (r_s = 0.12; p > 0.05). For children ≥9 years old, correlation between Likert and STAI-C remained moderate (r_s = 0.52; p < 0.0001); STAI-C and m-YPAS were unrelated (r_s = 0.10; p > 0.05).

Conclusions: Children in the ED experienced moderate-elevated state anxiety. Likert scale may be an acceptable substitute for STAI-C state. Further studies of this scale will aid in identifying patients with anxiety to facilitate timely management.

Keywords: Anxiety; Emergency department; Likert; Pediatrics.