Measuring negative behavior change: a pilot study determining feasibility and baseline rate in measures of quality of life and behavior of children after day case ENT surgery and anesthesia

Abstract

Aim: To determine the feasibility and baseline rate in measures of quality of life and behavior of children after day case ENT surgery and anaesthesia.Background: Negative behavior change post anesthesia has been reported in previous studies to varying degrees [1–3]. Variation may be because of the scales used to measure change. The Post Hospitalization Behavior Questionnaire (PHBQ) [4] has been commonly used to detect these behavior changes. Another scale, the Pediatric Quality of Life Inventory Generic Core Scales version 4.0 (pedsql) [5] is a validated quality of life questionnaire. It may prove superior in measuring behavior change post anesthesia but has not been used in this context. The comparative feasibility of using the scales and baseline rates of behavior is yet to be determined in this setting.Methods: The population was pediatric ENT day surgeries. After informed consent, demographic and medical data were collected. Questionnaires were performed preoperatively (Baseline), and postoperatively (Day 7 and 30).Results: Neither scale found evidence for substantial negative behavior change, with some negative changes in anxiety domains on the PHBQ and negative changes on the functional domains of the pedsql. Surprisingly, many children showed improvement in behavior. Both scales were equally feasible. Overall return rate was <50%.Conclusion: This pilot data can provide some baseline rates and data on feasibility to plan future intervention studies. In these studies, the anxiety domain of PHBQ may be the best scale to use but small changes indicate large numbers would be needed and particular strategies would be needed to increase follow‐up.References 1 Kotiniemi LH, Ryhanen PT, Moilanen IK. Behavioural changes in children following day‐case surgery: a 4‐week follow‐up of 551 children. Anaesthesia 1997;52(10): 970‐6.2 Kain ZN, Caldwell‐Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesthesia & Analgesia. 2004 of contents, 2004; 99(6): 1648‐54.3 Stargatt R, Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA et al. A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia. Paediatric Anaesthesia 2006; 16(8): 846‐59.4 Vernon DT, Schulman JL, Foley JM. Changes in children's behavior after hospitalization. Some dimensions of response and their correlates. American Journal of Diseases of Children 1966; 111(6): 581‐93.5 Varni JW, Seid M, Knight TS, Uzark K, Szer IS. The PedsQL 4.0 Generic Core Scales: sensitivity, responsiveness, and impact on clinical decision‐making. Journal of Behavioral Medicine 2002; 25(2): 175‐93.