Authors: Sablewski A et al.
Paediatric Anaesthesia. December 9, 2025. DOI: 10.1002/pan.70101
Summary
This prospective observational study evaluated how accurately anesthesiologists and parents can predict preoperative anxiety in young children aged 2–6 years during routine anesthesia consultation, and sought to identify early predictors of significant anxiety at induction. Preoperative anxiety in this age group is common and clinically relevant, as it is associated with adverse perioperative behaviors and outcomes, yet anesthesiologists often must make judgments based on very limited interaction.
The study analyzed 92 prediction sets in which both anesthesiologists and parents independently estimated the child’s anticipated anxiety at anesthesia induction using a visual analog scale (VAS). These predictions were compared with observed anxiety during induction, measured using the Modified Yale Preoperative Anxiety Scale—Short Form (mYPAS-SF). Significant anxiety was defined as an mYPAS-SF score greater than 30. Prediction accuracy was assessed using Spearman correlation and receiver operating characteristic (ROC) analysis.
Results demonstrated poor predictive performance overall. Correlation between predicted and observed anxiety was weak for parents and very weak for anesthesiologists. Discriminatory ability was limited for parents and essentially no better than chance for anesthesiologists. These findings highlight the difficulty of reliably anticipating anxiety in young children based solely on preoperative consultation impressions.
Importantly, the study identified simple and clinically practical predictors of anxiety. Children who responded positively to a greeting gesture, such as returning a “high-five,” had significantly lower anxiety scores at induction compared with those who did not engage. Additional factors associated with higher anxiety included younger child age, younger parental age, migration background, and the use of inhalational induction. These findings suggest that brief behavioral cues observed during consultation may be more informative than subjective prediction alone.
Key Points
Preoperative anxiety in children aged 2–6 is difficult to predict accurately during routine anesthesia consultation.
Parents slightly outperform anesthesiologists in predicting anxiety, but overall predictive accuracy remains poor.
Simple behavioral engagement, such as responding to a greeting, is strongly associated with lower anxiety at induction.
Higher anxiety is associated with younger age, migration background, and inhalational induction.
Incorporating brief behavioral assessment and individualized anxiety management strategies may improve early identification of at-risk children.
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