title: [Negative behavioral changes in children and adolescents after anesthesia : Development of a German language version of the Post Hospitalization Behavior Questionnaire].
abstract: BACKGROUND
  Negative behavioral changes after anesthesia in children are common. The Post Hospitalization Behavior Questionnaire (PHBQ) was particularly developed and has been widely used in English-speaking countries to investigate such behavioral changes. The PHBQ consists of 27 questions related to behavioral features observed by parents after anesthesia or hospitalization, each involving comparison with their baseline status.
  
  
  OBJECTIVE
  A comparable diagnostic tool in German should be established.
  
  
  METHODS
  The PHBQ was translated into German using a well defined back-translation method. A 3-point Likert scale was used to categorize behavioral features as less than, equal to or more than baseline. Overall 600 questionnaires were given out at children's hospital discharge, following surgical or medical procedures or examinations with or without concurrent anesthesia or deep sedation. After questionnaires were returned, factor and item analysis was conducted. Cronbach's alpha was calculated to determine internal consistency as a measure of reliability.
  
  
  RESULTS
  In total, 155 returned and completed questionnaires were assessed, with patients' age ranging from 1.1 to 15.9 (median 5.7) years and length of hospitalization between 1 to 15 (median 2.5) days. The German translation of the PHBQ has a factorial structure that is similar to the English version, and its psychometric properties are also similar. After analysis of the main components and consideration of the Scree plot, either 6 or 7 factors were indicated. Analogously to the original version, we chose 6 factors, which explain 58% of variance. Items were not identically assigned to factors as with the original version, and terms used to describe the factors were slightly adapted. Reliability was adequate, with Cronbach's alpha for the 6 factors being between 0.6 and 0.82 (for total scale: Cronbach's alpha = 0.89, compared to 0.82 for the original version). Children younger than 5 years showed more negative behavioral changes than older children. There were no gender differences.
  
  
  CONCLUSIONS
  With the German translation of the PHBQ presented here an instrument is available to detect negative behavioral changes after anesthesia in children among German speaking populations. The translation is comparable to the English version with minor differences concerning its factorial structure, which may be due to the predominant role of anxiety in all items. Like the original, this questionnaire does not per se discriminate between anesthesia and hospitalization induced behavioral changes. However, the German translation of the PHBQ is a questionnaire that is feasible for clinical routine and scientific settings and can be easily and quickly completed by caregivers.
authors.affiliation: Anästhesieabteilung, Universitäts-Kinderspital Zürich, Steinwiesstr. 75, 8032, Zürich, Schweiz, sabin.buehrer@kispi.uzh.ch.
authors.forename: S
authors.initials: S
authors.lastname: Buehrer
authors.forename: R
authors.initials: R
authors.lastname: Klaghofer
authors.forename: M
authors.initials: M
authors.lastname: Weiss
authors.forename: A
authors.initials: A
authors.lastname: Schmitz
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000758:Anesthesia / Q000009:adverse effects*; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology* / Q000523:psychology*; D002675:Child, Preschool; D005163:Factor Analysis, Statistical; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007802:Language; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000523:psychology*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires