Validity of the modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale for children in a preoperative setting

Abstract

Background: The perioperative period can be stressful for children and families. Minimizing child distress and investigating the quality of anesthetic care is important. There is a paucity of assessment tools available to assess perioperative anxiety in children.

Aim: To determine the validity and reliability of the modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale in a perioperative setting for children.

Methods: Children (n = 189, 3-12 years old) scheduled for ear, nose, and throat surgery had their anxiety rated at induction by a registered nurse anesthetist. Two observers individually evaluated video recordings of the perioperative period. The Verbal-Numeric-Anxiety-Fear-Rating-Scale was used to assess the children's preoperative anxiety and fear, and the modified-Distraction-Short-Scale was used to evaluate coping behavior. The modified-Yale-Preoperative-Anxiety-Scale was used to measure preoperative anxiety and behavioral compliance during anesthesia induction.

Results: Interrater reliability showed excellent agreement between observers on modified-Distraction-Short-Scale scores (weighted kappa (K_w ) = 0.91) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (K_w = 0.84). The agreements between the registered nurse anesthetist and observers were moderately good for modified-Distraction-Short-Scale (K_w = 0.65-0.80) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (K_w = 0.65-0.75). The intraclass correlation coefficient (ICC) for the registered nurse anesthetist and two observers was excellent for modified-Distraction-Short-Scale scores (ICC = 0.96) and Verbal-Numeric-Anxiety-Fear-Rating-Scale (ICC = 0.90). Regarding concurrent validity, modified-Distraction-Short-Scale and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores were strongly correlated among all three observers (Spearman's correlation coefficient [r_s ] = 0.75-0.82). The modified-Yale-Preoperative-Anxiety-Scale scores were moderately correlated with modified-Distraction-Short-Scale (r_s = 0.57-0.66) and Verbal-Numeric-Anxiety-Fear-Rating-Scale scores (r_s = 0.54-0.67). Construct validity was tested by using age as a discriminating variable, and Verbal-Numeric-Anxiety-Fear-Rating-Scale, modified-Distraction-Short-Scale, and modified-Yale-Preoperative-Anxiety-Scale scores were lower for the older age group; however, only modified-Distraction-Short-Scale (Observer 1: p = .035, Observer 2: p = .022), and modified-Yale-Preoperative-Anxiety-Scale scores were significantly lower (p < .001).

Conclusion: The modified-Distraction-Short-Scale and the Verbal-Numeric-Anxiety-Fear-Rating-Scale are simple and valid tools for assessing children's perioperative anxiety or fear and evaluating coping behavior. These results suggest that both scales are useful tools for routine clinical practice and research.

Keywords: anesthesia; anxiety; behavior; children; validation study.