At Dayton Children's, all patients with autism or other developmental delays are called prior
to the day of surgery by child life specialists to obtain a coping plan to be entered into
the EHR. Those patients that meet the criteria will be approached via telephone call 24-48
hours prior to procedure by the research team to describe the study and gauge interest in
participating.
The pilot study will recruit a total of sixty patients in two parallel groups randomized to
1:1 allocation: control group (standard practice with no sensory adaptive environment) or
intervention group (sensory adaptive environment). Patients will be randomized in varying
block sizes using a random number generator to ensure equal numbers in each group. The random
allocation, block sizes, and block sequences will be concealed from study personnel and each
patient until the time a patient is assigned to a group.
In the preoperative area of main campus perioperative services there are three dedicated
adaptive sensory friendly rooms for patients to await surgery. For the sensory adaptive
environment, the room will be set up in accordance with the patient's coping plan and
individual needs regarding sound, light, activity level, and other stimuli. The equipment may
include a portable popcorn tube with fiberoptic cart, handheld marble panel, color changing
floor tiles, other sensory friendly objects, and individual sensory toys.
After registration and informed consent, the patient will be placed in either a standard
preoperative room (control) or the dedicated sensory rooms (intervention) in the preoperative
surgery area based on prior randomization. The patient's behaviors will be recorded by a
research assistant at three time points (registration, nursing intake in preoperative room,
and immediately prior to transition to operating room) by utilizing the validated modified
Yale Preoperative Anxiety Scale (mYPAS). The mYPAS is the most widely used tool for assessing
preoperative anxiety in children. The total score on the mYPAS will be the primary outcome
for the study.
In addition to the mYPAS measurements, the patient will be evaluated in the operating room
utilizing the validated Child Induction Behavioral Assessment Scale (CIBA). The CIBA is a
3-category behavioral assessment for documenting children's behavioral responses to induction
of anesthesia. The 3 categories, Smooth, Moderate, and Difficult have associated behavioral
descriptions that are scored at the time of anesthesia induction. The CIBA will be evaluated
by the assigned anesthesia staff and documented in the EHR, as current standard practice.
While the patient is in the procedure, families will fill out two questionnaires in the
waiting room. The first is a 23-item questionnaire (Patient Experience Study Survey)
regarding the patient preoperative experience.
The second questionnaire is the Short Sensory Profile 2 (SSP-2), which assesses the patient's
sensory processing abilities. The SSP-2 score will be used as a surrogate for the severity of
sensory sensitivity in the study patient.
In addition to the SSP-2, the following independent variables will be extracted from the
medical record: patient demographics (sex, age, weight), ASA score designated by
anesthesiologist, diagnosis and health history, procedure, home medications, preoperative
medications including dose and route, intraoperative medications, event times and durations
(including preoperative wait time, transport to OR time, induction to anesthesia ready, case
length, & recovery time), and first recovery room pain score (documented by PACU RN via FLACC
score).
