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A Visual Analog Scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients

改進(jìn)的耶魯術(shù)前焦慮量表被廣泛用于評(píng)估麻醉誘導(dǎo)過(guò)程中兒童的焦慮，但需要經(jīng)過(guò)訓(xùn)練，且實(shí)施起來(lái)耗費(fèi)時(shí)間。相比之下，視覺(jué)模擬量表不需要訓(xùn)練，容易使用并且很快完成。本研究的目的是評(píng)價(jià)視覺(jué)模擬量表作為一種工具來(lái)評(píng)估在麻醉誘導(dǎo)期間患兒的焦慮以及如何區(qū)分焦慮和不焦慮患兒的有效性。

納入了401例（1.5-16歲）擇期行日間手術(shù)的患兒。麻醉誘導(dǎo)過(guò)程患兒的焦慮情況分別由父母、麻醉醫(yī)師通過(guò)視覺(jué)模擬量表以及一個(gè)訓(xùn)練有素的觀察員通過(guò)改良耶魯術(shù)前焦慮量表來(lái)評(píng)估。心理測(cè)量學(xué)特性評(píng)估有：（i）同時(shí)效度（父母、麻醉醫(yī)師的視覺(jué)模擬評(píng)分及改良耶魯術(shù)前焦慮量表得分之間的相關(guān)性）；（ii）結(jié)構(gòu)效度（亞組間的差異根據(jù)孩子的年齡和父母的焦慮用狀態(tài)-特質(zhì)焦慮量表評(píng)定）；（iii）使用布蘭德-奧特曼分析跨線人協(xié)議；（iv）區(qū)分焦慮和不焦慮患兒之間的分割點(diǎn)（參考：改良耶魯術(shù)前焦慮量表評(píng)分≥30）。

父母、麻醉醫(yī)師的視覺(jué)模擬評(píng)分及改良耶魯術(shù)前焦慮評(píng)分之間的相關(guān)性強(qiáng)（分別為0.68和0.73）。和大于6歲的患兒相比，小于5歲的患兒視覺(jué)模擬量表得分較高。高焦慮父母的患兒視覺(jué)模擬量表得分高于低焦慮父母的患兒。父母和麻醉醫(yī)生的視覺(jué)模擬評(píng)分的平均差為3.6，95%可信區(qū)間為（56.1至63.3）。父母、麻醉醫(yī)生視覺(jué)模擬評(píng)分分別≥37mm和≥30mm可確定患兒處于焦慮狀態(tài)。

本研究提供了視覺(jué)模擬量表評(píng)價(jià)麻醉誘導(dǎo)期間患兒焦慮有效性的初步數(shù)據(jù)。

原始文獻(xiàn)摘要

Johan M. Berghmans，Marten J. Poley; A Visual Analog Scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients ;Anesth Analg. 2017 Jul 14. doi: 10.1111/pan.13206.

Background: The modified Yale Preoperative Anxiety Scale is widely used to assess children’s anxiety during induction of anesthesia, but requires training and its admin- istration is time-consuming. A Visual Analog Scale, in contrast, requires no training, is easy-to-use and quickly completed.?Aim: The aim of this study was to evaluate a Visual Analog Scale as a tool to assess anxiety during induction of anesthesia and to determine cut-offs to distinguish between anxious and nonanxious children.?

Methods: Four hundred and one children (1.5-16 years) scheduled for daytime surgery were included. Children’s anxiety during induction was rated by parents and anesthesiologists on a Visual Analog Scale and by a trained observer on the modified Yale Preoperative Anxiety Scale. Psychometric properties assessed were: (i) concurrent validity (correlations between parents’ and anesthesiologists’ Visual Analog Scale and modified Yale Preoperative Anxiety Scale scores); (ii) construct validity (differences between subgroups according to the children’s age and the parents’ anxiety as assessed by the State-Trait Anxiety Inventory); (iii) cross-infor- mant agreement using Bland-Altman analysis; (iv) cut-offs to distinguish between anxious and nonanxious children (reference: modified Yale Preoperative Anxiety Scale ≥30).?

Results: Correlations between parents’ and anesthesiologists’ Visual Analog Scale and modified Yale Preoperative Anxiety Scale scores were strong (0.68 and 0.73, respectively). Visual Analog Scale scores were higher for children ≤5 years compared to children aged ≥6. Visual Analog Scale scores of children of high-anxious parents were higher than those of low-anxious parents. The mean difference between parents’ and anesthesiologists’ Visual Analog Scale scores was 3.6, with 95% limits of agreement (_56.1 to 63.3). To classify anx- ious children, cut-offs for parents (≥37 mm) and anesthesiologists (≥30 mm) were established.?

Conclusions: The present data provide preliminary data for the validity of a Visual Analog Scale to assess children’s anxiety during induction.