Predicting Anxiety in Children Aged 2–6 During Preoperative Anesthesia Consultation—A Prospective Observational Study

ABSTRACT Background Preoperative Anxiety in Young Children Is Common and Can Lead to Adverse Outcomes. In Clinical Routine, Anesthesiologists Must Often Predict Anxiety Based on Limited Interaction. Aims This study aimed to evaluate the accuracy of early anxiety predictions and to identify early predictors of heightened anxiety at anesthesia induction. Methods In this prospective observational study, anesthesiologists and parents of children aged 2–6 years undergoing elective procedures were asked during the preoperative consultation to predict the child's anxiety at anesthesia induction using the visual analog scale (VAS). These predictions were compared to observed anxiety during induction, measured with the Modified Yale Preoperative Anxiety Scale—Short Form (mYPAS‐SF). Prediction accuracy was assessed using Spearman's correlation ( r s ) and receiver operating characteristics (ROC) analysis. Potential predictors of significant anxiety defined as a mYPAS‐SF > 30 were analyzed. Results A total of 92 prediction sets were analyzed. Correlation between predicted and observed anxiety was weak for parents ( r s = 0.220, 95% CI 0.01–0.41) and very weak for anesthesiologists ( r s = 0.106, 95% CI −0.11–0.31). Predictive performance was limited for parents (AUC = 0.643) and negligible for anesthesiologists (AUC = 0.517). Children who responded positively to a greeting (‘high‐five’) during consultation showed significantly lower anxiety during anesthesia induction (median mYPAS‐SF score 34.4 [22.9–65.1] vs. 75.0 [45.8–90.6], p < 0.001). Significant anxiety was also associated with younger age of both children and parents, migration background, and inhalational induction. Conclusions Anxiety at induction remains difficult to predict during preoperative consultation. While parents performed slightly better than anesthesiologists, both lack sufficient precision. Simple behavioral cues, such as a response to a greeting, may help identify at‐risk children early. Future strategies should involve children and parents in individualized anxiety management. Trial Registration German Clinical Trials Registry, registration number: DRKS00035033