title: Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.
abstract: BACKGROUND
  Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g., perioperative), or provide only a static assessment of the child (e.g., level of anxiety). A simple, reliable, real-time tool is needed to appropriately identify children and parents whose behaviors in response to distressful events at any point in the perioperative continuum could benefit from timely behavioral intervention. Our specific aims were to (1) refine the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to improve its reliability in identifying perioperative behaviors and (2) validate the refined PACBIS against several established instruments.
  
  
  METHODS
  The PACBIS was used to assess the perioperative behaviors of 89 children aged 3 to 12 years presenting for adenotonsillectomy and their parents. Assessments using the PACBIS were made during perioperative events likely to prove distressing to children and/or parents (perioperative measurement of blood pressure, induction of anesthesia, and removal of the IV catheter before discharge). Static measurements of perioperative anxiety and behavioral compliance during anesthetic induction were made using the modified Yale Preoperative Anxiety Scale and the Induction Compliance Checklist (ICC). Each event was videotaped for later scoring using the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) and Observational Scale of Behavioral Distress (OSBD). Interrater reliability using linear weighted kappa (kappa(w)) and multiple validations using Spearman correlation coefficients were analyzed.
  
  
  RESULTS
  The PACBIS demonstrated good to excellent interrater reliability, with kappa(w) ranging from 0.62 to 0.94. The Child Coping and Child Distress subscores of the PACBIS demonstrated strong concurrent correlations with the modified Yale Preoperative Anxiety Scale, ICC, CAMPIS-SF, and OSBD. The Parent Positive subscore of the PACBIS correlated strongly with the CAMPIS-SF and OSBD, whereas the Parent Negative subscore showed significant correlation with the ICC. The PACBIS has strong construct and predictive validities.
  
  
  CONCLUSIONS
  The PACBIS is a simple, easy to use, real-time instrument to evaluate perioperative behaviors of both children and parents. It has good to excellent interrater reliability and strong concurrent validity against currently accepted scales. The PACBIS offers a means to identify maladaptive child or parental behaviors in real time, making it possible to intervene to modify such behaviors in a timely fashion.
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. senthilkumar.sadhasivam@cchmc.org
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Sadhasivam
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Cohen
authors.forename: Liana
authors.initials: L
authors.lastname: Hosu
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Gorman
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Jing Fang
authors.initials: JF
authors.lastname: Jou
authors.forename: Nancy
authors.initials: N
authors.lastname: Samol
authors.forename: Alexandra
authors.initials: A
authors.lastname: Szabova
authors.forename: Nancy
authors.initials: N
authors.lastname: Hagerman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hein
authors.forename: Anne
authors.initials: A
authors.lastname: Boat
authors.forename: Anna
authors.initials: A
authors.lastname: Varughese
authors.forename: Charles Dean
authors.initials: CD
authors.lastname: Kurth
authors.forename: J Paul
authors.initials: JP
authors.lastname: Willging
authors.forename: Joel B
authors.initials: JB
authors.lastname: Gunter
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000465:Algorithms; D001007:Anxiety / Q000523:psychology; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D004644:Emotions; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D015588:Observer Variation; D010290:Parents; D019990:Perioperative Care; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011581:Psychological Tests; D015203:Reproducibility of Results