title: The perioperative validity of the visual analog anxiety scale in children: a discriminant and useful instrument in routine clinical practice to optimize postoperative pain management.
abstract: BACKGROUND
  Because children's anxiety influences pain perception, perioperative anxiety should be evaluated in clinical practice with a unique, useful, and valid tool to optimize pain management. In this study, we evaluated psychometric properties of the visual analog scale (VAS)-anxiety for children and to study its perioperative relevance in clinical practice.
  
  
  METHODS
  One hundred children scheduled for elective surgery and general anesthesia were included. VAS-anxiety was measured at four timepoints and compared with both versions of State Spielbergers' questionnaires (State-Trait Anxiety Inventory for Youth [STAIY] and State-Trait Anxiety Inventory for Children [STAIC]) and the modified Yale Preoperative Anxiety Scale. Children's pain, parents' anxiety, and parents' proxy report of children's anxiety were evaluated using VAS.
  
  
  RESULTS
  The correlation between STAIC and VAS-anxiety was significant on the day of discharge. Moreover, changes over time were not significant with STAIC, whereas VAS-anxiety was significantly sensitive to changes over time in the two groups of age (7-11 yr and 12-16 yr). A receiver operating characteristic curve, using modified Yale Preoperative Anxiety Scale as reference, determined a VAS-anxiety cutoff at 30 to identify high-anxiety groups. Pain levels were significantly higher when children were anxious (VAS > or = 30) in the postoperative period. Moreover, children's anxiety and pain were higher when parents were anxious.
  
  
  CONCLUSIONS
  VAS-anxiety is a useful and valid tool to assess perioperative anxiety in children aged 7-16 yr. The influence of children's and parents' anxiety on children's postoperative pain suggests that VAS-anxiety should be recommended routinely for postoperative clinical practice to optimize anxiety and pain management.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. s-bringuierbranchereau@chu-montpellier.fr
authors.forename: Sophie
authors.initials: S
authors.lastname: Bringuier
authors.forename: Christophe
authors.initials: C
authors.lastname: Dadure
authors.forename: Olivier
authors.initials: O
authors.lastname: Raux
authors.forename: Amandine
authors.initials: A
authors.lastname: Dubois
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Picot
authors.forename: Xavier
authors.initials: X
authors.lastname: Capdevila
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D010147:Pain Measurement / Q000295:instrumentation*; D010149:Postoperative Pain / Q000175:diagnosis; D010290:Parents; D011594:Psychometrics; D012372:ROC Curve; D015203:Reproducibility of Results