Bian Liuxia, Zhang Tingting, Wu Yushan, Shan Xiaomin
Department of Admission Preparation Center, Children's Hospital Affiliated to Zhejiang University School of Medicine, No.57, Bamboo Pole Lane, Yan'an Road, Gongshu District, Hangzhou, 310000, China.
Department of Day Surgery Centre, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China.
BMC Pediatr. 2025 Apr 14;25(1):292. doi: 10.1186/s12887-025-05571-2.
Preoperative fear in pediatric patients can significantly impact their psychological well-being and complicate perioperative care. Traditional hospital environments may exacerbate anxiety in children undergoing elective surgeries, especially given developmental differences across ages 2 to 12.
In a retrospective hospital-based nested case-control study embedded within a cohort, we examined 188 children aged 2 to 12 admitted for elective surgery between March 2023 and March 2024. Participants met specific inclusion criteria and We defined cases as those with a Child Medical Fear Scale (CMFS) score > 30 (High Fear Group) and controls as those with CMFS ≤ 30 (Low Fear Group). Further stratification was based on hospitalization in conventional wards a conventional environment versus specially designed wards featuring "child-friendly visual intervention strategies" (e.g., cartoon themes, interactive toys, multimedia TVs). Standard Routine pre-hospital care (Treatment as Usual) and detailed procedural explanations were provided. Fear Preoperative fear was assessed using the CMFS at admission and before surgery, while parental satisfaction was evaluated with the Patient Satisfaction Questionnaire Short Form (PSQ-18).
Among 188 children (mean age 7.57 ± 2.15 years; 64/124 male), 74 cases (high fear) and 71 controls (low fear) were analyzed. No significant demographic differences were observed between groups. Key correlates of higher fear included lower educational status (OR = 0.400, 95% CI = 0.200-0.801; P = 0.010) and higher ASA status (OR = 2.273, 95% CI = 1.035-4.989; P = 0.041). Environmental stressors such as visibility of sharp instruments (OR = 2.294, 95% CI = 1.048-5.021; P = 0.038) and observing injections (OR = 2.565, 95% CI = 1.183-5.557; P = 0.017) were significant anxiety factors. The child-friendly intervention group (n = 43) exhibited significantly lower fear scores across all dimensions compared to the conventional group (n = 35), with a higher proportion achieving CMFS ≤ 30 (76.74% vs. 51.43%; P = 0.019) and greater parental satisfaction (79.07% vs. 51.43%; P = 0.010).
Both individual (e.g., educational status, past hospital experiences) and environmental factors (e.g., visibility of needles) play critical roles in pediatric preoperative fear. Implementing child-friendly visual interventions significantly alleviates reduces anxiety and improves parental satisfaction. These findings Our results support the adoption of such strategies in pediatric surgical care and highlight the importance of age-appropriate interventions.
儿科患者术前恐惧会显著影响其心理健康，并使围手术期护理复杂化。传统的医院环境可能会加剧接受择期手术儿童的焦虑，尤其是考虑到2至12岁儿童的发育差异。
在一项基于医院的回顾性巢式病例对照研究中，该研究嵌套于一个队列中，我们调查了2023年3月至2024年3月期间因择期手术入院的188名2至12岁儿童。参与者符合特定的纳入标准，我们将病例定义为儿童医学恐惧量表（CMFS）得分>30的儿童（高恐惧组），将对照组定义为CMFS≤30的儿童（低恐惧组）。进一步的分层基于在传统病房（传统环境）与采用“儿童友好视觉干预策略”（如卡通主题、互动玩具、多媒体电视）的专门设计病房中的住院情况。提供标准的常规院前护理（照常治疗）和详细的程序解释。术前恐惧在入院时和手术前使用CMFS进行评估，而家长满意度则通过患者满意度问卷简表（PSQ-18）进行评估。
在188名儿童（平均年龄7.57±2.15岁；64/124为男性）中，分析了74例（高恐惧）和71例对照组（低恐惧）。两组之间未观察到显著的人口统计学差异。较高恐惧的关键相关因素包括较低的教育水平（OR = 0.400，95% CI = 0.200 - 0.801；P = 0.010）和较高的美国麻醉医师协会（ASA）分级（OR = 2.273，95% CI = 1.035 - 4.989；P = 0.041）。诸如尖锐器械的可见度（OR = 2.294，95% CI = 1.048 - 5.021；P = 0.038）和观察注射（OR = 2.565，95% CI = 1.183 - 5.557；P = 0.017）等环境应激源是显著的焦虑因素。与传统组（n = 35）相比，儿童友好干预组（n = 43）在所有维度上的恐惧得分均显著较低，达到CMFS≤30的比例更高（76.74%对51.43%；P = 0.019），家长满意度更高（79.07%对51.43%；P = 0.010）。
个体因素（如教育水平、过去的住院经历）和环境因素（如针头的可见度）在儿科术前恐惧中都起着关键作用。实施儿童友好的视觉干预可显著减轻焦虑并提高家长满意度。我们的研究结果支持在儿科手术护理中采用此类策略，并强调了适合年龄的干预措施的重要性。
