{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:11:25Z","timestamp":1789031485285,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100021783","name":"Foundation of the Pennsylvania Medical Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100021783","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative anxiety affects most children undergoing surgery and predicts emergence delirium, postoperative pain, and behavioral change. The validated modified Yale Preoperative Anxiety Scale (mYPAS) is scored at only a few discrete timepoints, leaving physiologic status between assessments unmeasured.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We tested whether continuous wearable heart rate correlates with the mYPAS where scored, and whether heart\u2010rate elevations of undetermined cause occur during intervals without concurrent mYPAS observation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Children aged 4\u201317 undergoing elective surgery wore a wrist biosensor (Empatica EmbracePlus) from holding through induction; the mYPAS was scored at consent, parental separation, and induction. We assessed heart rate\u2013mYPAS concordance and the proportion of heart\u2010rate elevations falling outside \u00b15\u2009min of any mYPAS timepoint, stratified by premedication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 32 consented children, 15 were analyzable (median age 10\u2009years, nine male, eight premedicated). Induction\u2010window heart rate correlated with induction anxiety (Spearman\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.55, 95% CI 0.01\u20130.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034) and rose into induction in 13 of 15 children (median\u2009+\u200910 beats\/min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022). Of 90 heart\u2010rate elevations among 14 children with reliable timing, 71% fell outside the assessment windows (95% CI 58%\u201380%); 12 of 14 (86%) had \u2265\u20091 event outside all assessment windows. This pattern persisted regardless of premedication. Heart rate tracked children's state self\u2010report (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.62, ages \u2265\u20099) but not trait anxiety; informants agreed modestly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this small feasibility cohort, wrist\u2010derived induction\u2010window heart rate was associated with concurrent mYPAS scores. The majority of heart\u2010rate elevations of undetermined cause occurred outside scheduled mYPAS assessment windows. These exploratory findings require confirmation in a larger study incorporating raw physiologic signals, motion measurement, and continuous or event\u2010linked behavioral assessment, which would establish whether continuous physiologic monitoring can complement intermittent behavioral assessment by identifying physiologic events occurring between scheduled anxiety assessments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pan.70309","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:01:12Z","timestamp":1789030872000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuous Wrist\u2010Derived Heart Rate Correlates With m\n                    <scp>YPAS<\/scp>\n                    Scores and Detects Between\u2010Assessment Heart\u2010Rate Elevations in Children: A Feasibility Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4881-8093","authenticated-orcid":false,"given":"Shawn D.","family":"Safford","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery UPMC Children's Hospital Harrisburg  Harrisburg Pennsylvania USA"},{"name":"Department of Surgery University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6485-8386","authenticated-orcid":false,"given":"Sikiru","family":"Adewale","sequence":"additional","affiliation":[{"name":"Department of Computer Science Virginia Tech  Blacksburg Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6831-2818","authenticated-orcid":false,"given":"Denis","family":"Gracanin","sequence":"additional","affiliation":[{"name":"Department of Computer Science Virginia Tech  Blacksburg Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"issue":"12","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1001\/archpedi.1996.02170370016002","article-title":"Preoperative Anxiety in Children: Predictors and Outcomes","volume":"150","author":"Kain Z. N.","year":"1996","journal-title":"Archives of Pediatrics & Adolescent Medicine"},{"issue":"6","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1213\/01.ANE.0000136471.36680.97","article-title":"Preoperative Anxiety and Emergence Delirium and Postoperative Maladaptive Behaviors","volume":"99","author":"Kain Z. N.","year":"2004","journal-title":"Anesthesia and Analgesia"},{"issue":"5","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1097\/00000542-200405000-00015","article-title":"Development and Psychometric Evaluation of the Pediatric Anesthesia Emergence Delirium (PAED) Scale","volume":"100","author":"Sikich N.","year":"2004","journal-title":"Anesthesiology"},{"issue":"2","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1542\/peds.2005-2920","article-title":"Preoperative Anxiety, Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery","volume":"118","author":"Kain Z. N.","year":"2006","journal-title":"Pediatrics"},{"issue":"1","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.anclin.2013.10.011","article-title":"Preoperative Anxiety Management, Emergence Delirium, and Postoperative Behavior","volume":"32","author":"Banchs R. J.","year":"2014","journal-title":"Anesthesiology Clinics"},{"issue":"4","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1213\/00000539-199710000-00012","article-title":"The Yale Preoperative Anxiety Scale: How Does It Compare With a \u201cGold Standard\u201d?","volume":"85","author":"Kain Z. N.","year":"1997","journal-title":"Anesthesia and Analgesia"},{"issue":"2","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","DOI":"10.1111\/psyp.70004","article-title":"Quality in Question: Assessing the Accuracy of Four Heart Rate Wearables and the Implications for Psychophysiological Research","volume":"62","author":"Sinichi M.","year":"2025","journal-title":"Psychophysiology"},{"issue":"5","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart Rate Variability: Standards of Measurement, Physiological Interpretation, and Clinical Use","volume":"93","author":"Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology","year":"1996","journal-title":"Circulation"},{"key":"e_1_2_11_10_1","article-title":"Reference Frame and Channel Informativeness Shape Apparent Performance in Pediatric Wearable Stress Detection","author":"Safford S. D.","journal-title":"Biomedical Physics & Engineering Express"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/neu.2023.19"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13536"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.12.022"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877\u2010024\u201001210\u2010w"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70309","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pan.70309","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pan.70309","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:01:14Z","timestamp":1789030874000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pan.70309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":13,"alternative-id":["10.1002\/pan.70309"],"URL":"https:\/\/doi.org\/10.1002\/pan.70309","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"assertion":[{"value":"2026-06-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pan.70309"}}