Assessment tools used to measure postoperative behavioral changes in children, a narrative review

Context: Previous studies have shown a high prevalence of postoperative behavior changes in children. To assess postoperative behavior changes, various tools have been used and the understanding of their psychometric characteristics namely validity, reliability and norming is essential. Objective: To provide an overview of the different assessment tools used to measure postoperative behavior changes in children and their psychometrics. Methods: Data sources: MEDLINE, EMbase, Web of Science and Google Scholar. Study selection: inclusion of studies published between January 1995- June 2023 and searched with the following key terms: 'anesthesia', 'postoperative behavior' and 'child' and MESH terms 'postoperative period', 'behavior' and 'child'. Data extraction and data synthesis: a data extraction form was used and due to heterogeneity, the findings are presented as a narrative review. Results: In the final analysis, 57 articles were withheld and 11 assessment tools identified which were used to measure postoperative behavior changes. In the majority of these studies, the Post Hospitalization Behavior Questionnaire (PHBQ) and its adaptation namely the Post Hospitalization Behavior Questionnaire for ambulatory surgery (PHBQ-AS) were used. Although frequently applied, the validity, reliability and norming of both questionnaires have not been well established. Other tools like the Child Behavior Checklist, the Strengths and Difficulties Questionnaire and Infant/Toddler Sensory Profile have been well validated and are reliable. However, these tools were not specifically designed for assessment of postoperative behavior changes in children after surgery. Conclusions: There is a lack of well validated and reliable tools to assess postoperative behavior in children both for clinical and research purposes.