Perioperative Measures Predict Child’s Ability to Cope

CHICAGO – A newly developed assessment tool can identify child and parent coping behaviors, and ultimately could be used to guide real-time behavioral and medical interventions to make the perioperative experience less traumatic for children.

Research on the novel assessment tool called the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) earned a "Best Clinical Abstract" award at the annual meeting of the American Society of Anesthesiologists.

"Behavioral factors during pediatric surgery significantly contribute to postoperative outcomes, including delayed hospital discharge and poor parental satisfaction. While the existing real-time scales identify preoperative anxiety, they are limited because they don’t assess children’s coping efforts or parent behaviors," said Dr. Nancy Hagerman of Cincinnati Children’s Hospital Medical Center.

With PACBIS, if the child is anxious and the parent is exhibiting distress-promoting behavior during induction, an anesthesiologist can distract the child and engage the parents in the process of distraction and nonprocedural talk. If the child has excessive anxiety before anesthesia, child life specialists can explain to the child and parents what to expect during induction, offer sedation, or teach parents how to promote coping behaviors by engaging their child in nonprocedural discussions and distractions during induction of anesthesia.

PACBIS uses a scale of 1-5, with 1 being the lowest, to rate child coping and distress as well as parent and staff promotion of coping and distress (Anesth. Analg. 2009;108:822-6).

The study correlated PACBIS results with postoperative and postdischarge maladaptive behaviors by prospectively assessing 405 children, aged 3-12 years, undergoing tonsillectomies and adenoidectomies and their parents before surgery, during induction of anesthesia, upon emergence, and in the pediatric acute care unit with removal of the parenteral intravenous lines.

The researchers assessed for coping, distress, and anxiety behaviors using the PACBIS, the modified Yale Preoperative Anxiety Scale (mYPAS), and the Induction Compliance Checklist (ICC). They correlated findings on the PACBIS with postoperative pain and behavioral outcomes using the Pediatric Anesthesia Emergence Delirium (PAED) scores, the Post-discharge Parental Pain Measurements (PPPM), and Post-Hospitalization Behavior Questionnaire (PHBQ) on day 1 and day 7 (or later) after surgery (Anesthesiology 2004;100:1138-45).

"The PACBIS strongly predicted postoperative and postdischarge maladaptive behaviors and postoperative pain in children" undergoing tonsillectomy or adenoidectomy, Dr. Hagerman said. The PACBIS had strong concurrent validity with existing scales in assessing perioperative behaviors at all phases, perhaps most importantly during induction of anesthesia.

The PACBIS measures of child and parent coping and distress correlated well with those of the PAED, PPPM, and PHBQ. A 2-unit increase in PACBIS child distress measure during induction correlated with a 6-point increase in the PAED. As the PACBIS child coping measure improved 2 units (mild = 0; extreme = 2), there was a 45% reduction in the odds of the child having severe pain as measured by the PPPM on postoperative days 1-2. A preoperative child distress increase of 2 units was associated with a 4.6-fold increase in the odds of having severe pain as measured by the PPPM on postoperative days 7-8.

Higher PACBIS child distress during induction was associated with increased separation anxiety, sleep disturbances, aggression, and withdrawal (P less than .01). Higher parent distress on the PACBIS during induction was associated with increased separation anxiety and sleep disturbances (P less than .01).

Higher parent coping on the PACBIS during induction was associated with less withdrawal (P less than .01) and fewer eating disturbances (P less than .05).

The parents’ scores are very important, Dr. Hagerman emphasized, in keeping children calm during the surgical experience. "Parents who cope well and provide distracting nonprocedural talk help their child reduce distress and emergence delirium, postoperative pain, and new-onset maladaptive behaviors," she said, adding that members of the surgical team are also influential in achieving optimal perioperative behavioral outcomes.

Dr. Hagerman said she had no relevant conflicts of interest.

CHICAGO – A newly developed assessment tool can identify child and parent coping behaviors, and ultimately could be used to guide real-time behavioral and medical interventions to make the perioperative experience less traumatic for children.

Research on the novel assessment tool called the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) earned a "Best Clinical Abstract" award at the annual meeting of the American Society of Anesthesiologists.

"Behavioral factors during pediatric surgery significantly contribute to postoperative outcomes, including delayed hospital discharge and poor parental satisfaction. While the existing real-time scales identify preoperative anxiety, they are limited because they don’t assess children’s coping efforts or parent behaviors," said Dr. Nancy Hagerman of Cincinnati Children’s Hospital Medical Center.

With PACBIS, if the child is anxious and the parent is exhibiting distress-promoting behavior during induction, an anesthesiologist can distract the child and engage the parents in the process of distraction and nonprocedural talk. If the child has excessive anxiety before anesthesia, child life specialists can explain to the child and parents what to expect during induction, offer sedation, or teach parents how to promote coping behaviors by engaging their child in nonprocedural discussions and distractions during induction of anesthesia.

PACBIS uses a scale of 1-5, with 1 being the lowest, to rate child coping and distress as well as parent and staff promotion of coping and distress (Anesth. Analg. 2009;108:822-6).

The study correlated PACBIS results with postoperative and postdischarge maladaptive behaviors by prospectively assessing 405 children, aged 3-12 years, undergoing tonsillectomies and adenoidectomies and their parents before surgery, during induction of anesthesia, upon emergence, and in the pediatric acute care unit with removal of the parenteral intravenous lines.

The researchers assessed for coping, distress, and anxiety behaviors using the PACBIS, the modified Yale Preoperative Anxiety Scale (mYPAS), and the Induction Compliance Checklist (ICC). They correlated findings on the PACBIS with postoperative pain and behavioral outcomes using the Pediatric Anesthesia Emergence Delirium (PAED) scores, the Post-discharge Parental Pain Measurements (PPPM), and Post-Hospitalization Behavior Questionnaire (PHBQ) on day 1 and day 7 (or later) after surgery (Anesthesiology 2004;100:1138-45).

"The PACBIS strongly predicted postoperative and postdischarge maladaptive behaviors and postoperative pain in children" undergoing tonsillectomy or adenoidectomy, Dr. Hagerman said. The PACBIS had strong concurrent validity with existing scales in assessing perioperative behaviors at all phases, perhaps most importantly during induction of anesthesia.

The PACBIS measures of child and parent coping and distress correlated well with those of the PAED, PPPM, and PHBQ. A 2-unit increase in PACBIS child distress measure during induction correlated with a 6-point increase in the PAED. As the PACBIS child coping measure improved 2 units (mild = 0; extreme = 2), there was a 45% reduction in the odds of the child having severe pain as measured by the PPPM on postoperative days 1-2. A preoperative child distress increase of 2 units was associated with a 4.6-fold increase in the odds of having severe pain as measured by the PPPM on postoperative days 7-8.

Higher PACBIS child distress during induction was associated with increased separation anxiety, sleep disturbances, aggression, and withdrawal (P less than .01). Higher parent distress on the PACBIS during induction was associated with increased separation anxiety and sleep disturbances (P less than .01).

Higher parent coping on the PACBIS during induction was associated with less withdrawal (P less than .01) and fewer eating disturbances (P less than .05).

The parents’ scores are very important, Dr. Hagerman emphasized, in keeping children calm during the surgical experience. "Parents who cope well and provide distracting nonprocedural talk help their child reduce distress and emergence delirium, postoperative pain, and new-onset maladaptive behaviors," she said, adding that members of the surgical team are also influential in achieving optimal perioperative behavioral outcomes.

Dr. Hagerman said she had no relevant conflicts of interest.

CHICAGO – A newly developed assessment tool can identify child and parent coping behaviors, and ultimately could be used to guide real-time behavioral and medical interventions to make the perioperative experience less traumatic for children.

Research on the novel assessment tool called the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) earned a "Best Clinical Abstract" award at the annual meeting of the American Society of Anesthesiologists.

"Behavioral factors during pediatric surgery significantly contribute to postoperative outcomes, including delayed hospital discharge and poor parental satisfaction. While the existing real-time scales identify preoperative anxiety, they are limited because they don’t assess children’s coping efforts or parent behaviors," said Dr. Nancy Hagerman of Cincinnati Children’s Hospital Medical Center.

With PACBIS, if the child is anxious and the parent is exhibiting distress-promoting behavior during induction, an anesthesiologist can distract the child and engage the parents in the process of distraction and nonprocedural talk. If the child has excessive anxiety before anesthesia, child life specialists can explain to the child and parents what to expect during induction, offer sedation, or teach parents how to promote coping behaviors by engaging their child in nonprocedural discussions and distractions during induction of anesthesia.

PACBIS uses a scale of 1-5, with 1 being the lowest, to rate child coping and distress as well as parent and staff promotion of coping and distress (Anesth. Analg. 2009;108:822-6).

The study correlated PACBIS results with postoperative and postdischarge maladaptive behaviors by prospectively assessing 405 children, aged 3-12 years, undergoing tonsillectomies and adenoidectomies and their parents before surgery, during induction of anesthesia, upon emergence, and in the pediatric acute care unit with removal of the parenteral intravenous lines.

The researchers assessed for coping, distress, and anxiety behaviors using the PACBIS, the modified Yale Preoperative Anxiety Scale (mYPAS), and the Induction Compliance Checklist (ICC). They correlated findings on the PACBIS with postoperative pain and behavioral outcomes using the Pediatric Anesthesia Emergence Delirium (PAED) scores, the Post-discharge Parental Pain Measurements (PPPM), and Post-Hospitalization Behavior Questionnaire (PHBQ) on day 1 and day 7 (or later) after surgery (Anesthesiology 2004;100:1138-45).

"The PACBIS strongly predicted postoperative and postdischarge maladaptive behaviors and postoperative pain in children" undergoing tonsillectomy or adenoidectomy, Dr. Hagerman said. The PACBIS had strong concurrent validity with existing scales in assessing perioperative behaviors at all phases, perhaps most importantly during induction of anesthesia.

The PACBIS measures of child and parent coping and distress correlated well with those of the PAED, PPPM, and PHBQ. A 2-unit increase in PACBIS child distress measure during induction correlated with a 6-point increase in the PAED. As the PACBIS child coping measure improved 2 units (mild = 0; extreme = 2), there was a 45% reduction in the odds of the child having severe pain as measured by the PPPM on postoperative days 1-2. A preoperative child distress increase of 2 units was associated with a 4.6-fold increase in the odds of having severe pain as measured by the PPPM on postoperative days 7-8.

Higher PACBIS child distress during induction was associated with increased separation anxiety, sleep disturbances, aggression, and withdrawal (P less than .01). Higher parent distress on the PACBIS during induction was associated with increased separation anxiety and sleep disturbances (P less than .01).

Higher parent coping on the PACBIS during induction was associated with less withdrawal (P less than .01) and fewer eating disturbances (P less than .05).

The parents’ scores are very important, Dr. Hagerman emphasized, in keeping children calm during the surgical experience. "Parents who cope well and provide distracting nonprocedural talk help their child reduce distress and emergence delirium, postoperative pain, and new-onset maladaptive behaviors," she said, adding that members of the surgical team are also influential in achieving optimal perioperative behavioral outcomes.

Dr. Hagerman said she had no relevant conflicts of interest.