Behavior changes after minor emergency procedures.
OBJECTIVE
Procedures are common in pediatric emergency departments and frequently cause distress from pain and/or anxiety. The objective of this study was to describe the incidence, types, and magnitude of long-term behavior changes after procedures in the emergency setting.


METHODS
This is a descriptive pilot study to determine if children display negative behavioral changes after a minor emergency department procedure (abscess drainage or laceration repair). Behavior change was measured at 1 week by telephone follow-up using the 27-item Post Hospitalization Behavior Questionnaire, a well-validated instrument that measures behavior changes across 6 categories: general anxiety, separation anxiety, anxiety about sleep, eating disturbances, aggression toward authority, and apathy/withdrawal. Significant behavior change was defined as 5 or more negative behavior changes on the 27-item questionnaire.


RESULTS
Twenty percent of children who underwent abscess drainage (n = 30) and 20% who underwent laceration repair (n = 30) displayed significant negative behavior change at 1 week. Children who displayed significant negative behavior change tended to be younger (3.6 vs 5.9 years) and trended toward being more likely to have received anxiolysis or sedation (16.7% vs 8.3%). Separation anxiety, sleep difficulties, and aggression toward authority were the most common behavior changes.


CONCLUSIONS
In this pilot study, a significant percentage of children undergoing common emergency procedures exhibited an appreciable burden of negative behavior change at 1 week; these results demonstrate the need for further rigorous investigation of predictors of these changes and interventions, which can ameliorate these changes.
From the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Holly
H
Brodzinski
Srikant
S
Iyer
D000038:Abscess / Q000601:surgery*; D000772:Anesthesia, Local; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001010:Anxiety, Separation / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects / Q000523:psychology; D004636:Emergency Service, Hospital; D004644:Emotions; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D022125:Lacerations / Q000628:therapy*; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D010865:Pilot Projects; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000523:psychology*
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives