Prediction of anxiety in children aged 7–12 during preoperative anaesthesia evaluation – a prospective observational study

Preoperative anxiety is a common challenge in paediatric anaesthesia. High anxiety levels are associated with adverse perioperative outcomes. Although risk factors for preoperative anxiety in children are well known, validated assessment tools are rarely used in everyday clinical practice. Instead, anaesthesiologists rely on clinical judgment during preoperative assessments. However, the accuracy of such anxiety predictions in clinical practice remains unclear. This prospective observational study included children aged 7–12 years undergoing elective surgery or diagnostic procedures under general anaesthesia. During the preoperative consultation, anaesthesiologists, parents, and children were asked to predict the child’s anxiety on a Visual Analogue Scale (VAS), while actual anxiety during anaesthesia induction was assessed using the Modified Yale Preoperative Anxiety Scale – Short Form (mYPAS-SF). Spearman’s correlations (rs) between predicted and observed anxiety were calculated, and the predictive performance for clinically significant anxiety (defined as mYPAS-SF > 30) was evaluated using the area under the receiver operating characteristic curve (AUC). Potential predictors of preoperative anxiety, including demographic and psychosocial factors, were also evaluated. 91 datasets sets were analysed. Anxiety prediction by parents correlated moderate to children’s anxiety during anaesthesia induction (AUC 0.661; rs=0.327, 95% CI 0.12–0.51). Anxiety predictions by anaesthesiologists (AUC 0.604; rs=0.173, 95% CI -0.04–0.37) and children (AUC 0.612; rs=0.147, 95% CI -0.08–0.36) correlated weakly with children’s anxiety. Children reporting being worried before anaesthesia showed significantly higher anxiety during induction (mYPAS-SF 38.5 [22.9–57.3] vs. 22.9 [22.9–38.0]; P = 0.006). Children’s anxiety at consultation and on the ward correlated with increased anxiety during induction (rs=0.271, 95% CI 0.06–0.46 and rs=0.297, 95% CI 0.09–0.48, respectively). Intravenous induction was associated with lower anxiety compared with inhalational induction (mYPAS-SF 22.9 22.9 [22.9–38.0] vs. 38.5 [22.9–57.3]; P < 0.001). No significant associations were found for age, gender, prior medical experiences, or parental anxiety. Clinical anxiety assessments in preoperative consultations are often inaccurate, with parents performing slightly better than anaesthesiologists and children. Structured screening approaches are needed to enhance the early identification of high-risk children and improve perioperative anxiety management. German Clinical Trials Registry, registration number DRKS00033395. Date of registration: 06/05/2024.