THE YALE PREOPERATIVE ANXIETY SCALE - HOW DOES IT COMPARE WITH A GOLDSTANDARD

Evaluating the effectiveness of interventions directed toward the trea tment of preoperative anxiety in children has been hindered by the abs ence of a statistically valid measurement tool. In a previous investig ation, we developed an instrument (Yale Preoperative Anxiety Scale [YP AS]) that can be used to assess anxiety in children undergoing inducti on of anesthesia. The purpose of the present investigation was to modi fy and Expand the applicability of the instrument to the preoperative holding area and to validate the modified instrument (m-YPAS) against a recognized ''gold standard'' (State-Trait Anxiety Inventory for Chil drens [STAIC]). Videotapes of children in a preoperative holding area were analyzed by the investigators. The existing live categories of th e YPAS were found to reflect most of the behaviors observed. Several i tems, however, were modified to describe new behaviors observed. Relia bility analysis using weighted kappa statistics revealed that interobs erver agreement ranged from 0.68 to 0.86, Whereas intraobserver weight ed kappa ranged from 0.63 to 0.90. Concurrent validity between the YPA S and the STAIC was acceptable (P = 0.01, r = 0.79). Construct validit y was high as assessed by increased m-YPAS scores from the preoperativ e holding area (28 +/- 8) to entering the operating room (35 +/- 12), to introduction of the anesthesia mask (43 +/- 15;F [1,36] = 0.6, P = 0.001]. Showing good to excellent observer reliability and high concur rent and construct validity, the m-YPAS proved to be an appropriate to ol for assessing children's anxiety during the perioperative period. I mplications: The absence of a statistically valid measurement tool tha t can be applied easily in perioperative settings hinders the evaluati on of interventions directed toward treatment of preoperative anxiety in children. The authors describe the development of such a tool, the modified Yale Preoperative Anxiety Scale.