A prospective, observational validation of HRAD, a novel pediatric affect and cooperation scale

Study objective: HRAD +/- was developed to quickly assess pediatric perioperative affect and cooperation. HRAD +/- represents: Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperativity. The primary aim of this study was to investigate the clinical utility of HRAD +/- as an affect and cooperation assessment tool for inhalational mask induction. Secondary aims examined inter-rater reliability (IRR) of HRAD +/- and predictive validity of induction HRAD +/- with emergence delirium. Design: This was a prospective observational investigation. Setting: We conducted this investigation at Lucile Packard Children's Hospital Stanford, an academic, quaternary care children's hospital in Northern California. Patients: A total of 197 patients were included in this investigation. Children 1-14 years of age, who underwent daytime procedures with inhalational induction of anesthesia and American Society of Anesthesiologists physical status I-III were eligible. Interventions: During mask induction, two trained research assistants (RAs) independently scored the patient's affect and cooperation. After extubation, the same investigators observed the patient's emergence. Measurements: RAs scored each mask induction using the following scales: HRAD +/-, modified Yale Preoperative Anxiety Scale (mYPAS), Observation Scale of Behavioral Distress (OSBD), and Induction Compliance Checklist (ICC). Correlations were calculated to HRAD +/-. IRR of HRAD +/- between the RAs as well as predictive validity of HRAD +/- to Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales were calculated. Main results: HRAD +/- scores strongly correlated with mYPAS (r = 0.840, p < 0.0001) with moderate correlation to OSBD (r = 0.685, p < 0.0001) and ICC (-0.663, p < 0.0001). IRR was moderate for the affect and cooperation portion of the HRAD +/- scale, respectively (kappa = 0.595 [p < 0.0001], kappa = 0.478 [p < 0.0001]). A weak correlation was observed with PAED (r = 0.134 [p = 0.0597]) vs HRAD +/-. No correlations were observed between Watcha (r = 0.013 [p = 0.8559]) and Cravero and HRAD +/- scales (r = 0.002 [p = 0.9767]). Conclusions: HRAD +/- is a clinically useful and simple scale for evaluating pediatric affect and cooperation during inhalational mask induction. Results demonstrate correlation with commonly utilized research assessment scales.