A prospective,observational study of a pediatric affect and cooperation scale (HRAD±) for vascular access procedures

Abstract

Background:

Anxiety is common in pediatric patients, especially during vascular access procedures. Most well-studied affect and anxiety scales, including the Observation Scale of Behavioral Distress-Revised (OSBD-r), the modified Yale Preoperative Anxiety Scale (mYPAS), and the modified Induction Compliance Checklist (mICC), are too cumbersome for clinical use outside of research settings. HRAD± (Happy, Relaxed, Anxious, Distressed with yes/no to cooperation) is a clinically-efficient observational scale that evaluates pediatric procedural affect and cooperation. This study examined the clinical utility of HRAD± during vascular access procedures in children. The aims were to investigate the correlation of HRAD± to highly reliable, research-based affect and cooperation scales and to assess inter-rater reliability (IRR) between observers in this setting.

Methods:

This was a prospective, observational study conducted at Lucile Packard Children’s Hospital Stanford. Inpatient participants were 1 month to 25 years old and undergoing a peripheral intravenous insertion or phlebotomy. Two trained research assistants (RAs) scored each patient independently during the vascular access procedure using HRAD±, OSBD-r, mYPAS, and mICC. Correlation analyses computed the associations between HRAD± and reference scales. IRR between RAs and vascular access providers was calculated using Fleiss’ Kappa.

Results:

A total of 234 patients were included. HRAD± scores strongly correlated with OSBD-r and mYPAS (p < 0.0001, p < 0.0001, respectively). The cooperation assessment of HRAD± demonstrated strong correlation to mICC (p < 0.0001). IRR of HRAD± between research assistants and vascular access providers showed moderate agreement (p < 0.0001).

Conclusion:

HRAD± demonstrated strong correlation to the reference affect and cooperation scales. This study supports the utility of HRAD± for rapid assessment of pediatric procedural anxiety and cooperation during vascular access procedures. HRAD± can serve as a practical tool for facilitating clinical decisions, and its wider incorporation into healthcare settings would importantly guide targeted interventions to reduce patient anxiety.

Keywords

Anxiety child behavior vascular access peripheral IV validation studies

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References

Humphrey

Boon

van Linden van den Heuvell

, et al The occurrence of high levels of acute behavioral distress in children and adolescents undergoing routine venipunctures. Pediatrics 1992; 90(1 Pt 1): 87–91.

Kain

Mayes

Wang

S-M

, et al Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology 1999; 90(3): 758–765.

Kain

Mayes

Caldwell-Andrews

, et al Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics 2006; 118(2): 651–658.

Eijlers

Staals

Legerstee

, et al Predicting intense levels of child anxiety during anesthesia induction at hospital arrival. J Clin Psychol Med Settings 2021; 28(2): 313–322.

Alexander

Managing patient stress in pediatric radiology. Radiol Technol 2012; 83(6): 549–560.

McMurtry

Pillai Riddell

Taddio

, et al Far from “just a poke”: common painful needle procedures and the development of needle fear. Clin J Pain 2015; 31(10 Suppl): S3–11.

McLenon

Rogers

MAM

. The fear of needles: a systematic review and meta-analysis. J Adv Nurs 2019; 75(1): 30–42.

Gerçeker

GÖ

Ayar

Özdemir

, et al The impact of the difficult vascular access, fear, and anxiety level in children on the success of first-time phlebotomy. J Vasc Access 2018; 19(6): 620–625.

Sanna

Camporesi

Diotto

, et al Virtual sedation as a substitute to pharmacological sedation during PICC placement in pediatric patients: a feasibility study. J Vasc Access 2024; 25(1): 313–317.

10.

Wang

Thomas

Rodriguez

, et al Virtual reality for pediatric periprocedural care. Curr Opin Anaesthesiol 2021; 34(3): 284–291.

11.

Heikal

Stuart

Anxiolytic premedication for children. BJA Educ 2020; 20(7): 220–225.

12.

Friedrichsdorf

SJ.

Four steps to eliminate or reduce pain in children caused by needles (Part 1). Pain Manag 2017; 7(2): 89–94.

13.

Friedrichsdorf

SJ.

Multimodal Pediatric Pain Management (Part 2). Pain Manag 2017; 7(3): 161–166.

14.

Huang

Y-L

Huang

S-T

, et al Impact of music therapy on preoperative anxiety and degree of cooperation with anesthesia induction in children with simple congenital heart disease. J Perianesth Nurs 2021; 36(3): 243–246.

15.

Caruso

George

Menendez

, et al Virtual reality during pediatric vascular access: a pragmatic, prospective randomized, controlled trial. Pediatr Anesth 2020; 30(2): 116–123.

16.

Lunoe

Drendel

Levas

, et al A randomized clinical trial of Jet-Injected lidocaine to reduce venipuncture pain for young children. Ann Emerg Med 2015; 66(5): 466–474.

17.

Yun

Caruso

TJ.

Identification and treatment of pediatric perioperative anxiety. Anesthesiology 2024; 141(5): 973–983.

18.

Spielberger

Edwards

Montouri

et al. State-Trait Anxiety Inventory for Children (STAI-CH). Palo Alto, CA: Consulting Psychologists Press; 1973.

19.

Jay

Elliott

Ozolins

, et al Behavioral management of children’s distress during painful medical procedures. Behav Res Ther 1985; 23(5): 513–520.

20.

McMurtry

Noel

Chambers

, et al Children’s fear during procedural pain: preliminary investigation of the children’s fear Scale. Health Psychol 2011; 30(6): 780–788.

21.

Ersig

Kleiber

McCarthy

, et al Validation of a clinically useful measure of children’s state anxiety before medical procedures. J Spec Pediatr Nurs 2013; 18(4): 311–319.

22.

Yun

Kennedy

Caruso

TJ.

Perioperative pediatric anxiety: a cry for universal scale adoption. Pediatr Qual Saf 2022; 7(2): e542.

23.

Lopez

Children’s emotional manifestation scale: development and testing. J Clin Nurs 2005; 14(2): 223–229.

24.

Kennedy

Wang

Rodriguez

, et al Development and assessment of an efficient pediatric affect and cooperation scale. J Clin Anesth 2022; 76: 110569.

25.

Yun

Qian

Wang

, et al A prospective, observational validation of HRAD±, a novel pediatric affect and cooperation scale. J Clin Anesth 2024; 94: 111410.

26.

Watson

Clark

Tellegen

Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988; 54(6): 1063–1070.

27.

von Elm

Altman

Egger

, et al Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335(7624): 806–808.

28.

Kain

Mayes

Cicchetti

, et al

The Yale Preoperative Anxiety Scale: how does it compare with a ‘gold standard’?

Anesth Analg 1997; 85(4): 783–788.

29.

Kain

Mayes

Wang

, et al

Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective?

Anesthesiology 1998; 89(5): 1147–1156.

30.

Harris

Taylor

Thielke

, et al Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42(2): 377–381.

31.

Hicks

von Baeyer

Spafford

, et al The faces pain scale – revised: toward a common metric in pediatric pain measurement. Pain 2001; 93(2): 173–183.