Title:
A clinical tool to predict adverse behaviour in children at the induction of anesthesia.

Abstract:
To develop and validate a parent questionnaire to aid in predicting which children are likely to exhibit significant adverse behaviour at anesthetic induction.
Parents of 209 children, ages two to 13 yr, completed a brief questionnaire prior (13 items) to their child's anesthetic induction for surgery. The questionnaire included content drawn from both the literature and clinical experience. Results from the questionnaire were compared with the Induction Compliance Checklist (ICC), a validated tool to measure adverse behaviour at induction. Analyses assessing the correlation between each of the items and the total questionnaire score and between each item and the ICC score resulted in three items being removed from the questionnaire because they provided no predictive power. The association between the resulting ten-item parent questionnaire and the ICC was re-assessed using correlation. Hierarchical regression was used to evaluate the added value of our tool compared with the modified Yale Preoperative Anxiety Scale (mYPAS) in the prediction of ICC scores.
The Cronbach's alpha reliability coefficient for the ten-item parent questionnaire was 0.73. The Pearson product-moment correlation between the ten-item questionnaire and the ICC was 0.34 (P < 0.001) for all children and 0.38 (P < 0.001) for children not preoperatively sedated. Values represent medium effect sizes for the new questionnaire's predictive power. The parent questionnaire provided added value relative to the mYPAS in terms of correlation with the ICC.
Adverse behaviour at anesthesia induction is significantly predicted by our new parent questionnaire. Further refinement may improve predictive power beyond the observed medium effect size.