Research study · BMJ Open · 2026
Physiological-behavioural discordance in paediatric perioperative anxiety assessment: a scoping review protocol
Verified on PubMed Oxford CEBM Level 1A: Systematic Review & Meta-Analysis
A 2026 study in BMJ Open in anxiety. This is a plan for a future review, so it has no results yet. This protocol establishes only that the review is planned and how it will be conducted, not that children who look calm are actually under hidden stress.
In plain language
Study overview
Researchers planned a review of published studies on young children who look calm before surgery but show signs of stress inside the body. The review will look at how well a behaviour-based anxiety score matches heart and body measures of stress, and will record medicines children already take at home.
Findings
This is a plan for a future review, so it has no results yet. It sets out how the team will search the medical literature and what they will look for.
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The deeper readScientific analysis
Introduction: Preoperative anxiety in children is a common problem in paediatric surgical care. In current practice, anxiety is assessed mainly by behavioural rating scales, of which the modified Yale Preoperative Anxiety Scale (mYPAS) is the most widely used. However, behavioural observation may not capture children whose outward behaviour stays calm while their autonomic stress response is still high. This mismatch between visible behaviour and underlying physiology can lead to under-recognition of anxiety and may explain the modest correlations reported between behavioural scores and physiological markers in children. The aim of this scoping review is to map the published evidence on physiological–behavioural discordance during paediatric perioperative anxiety and to identify methodological gaps that future multimodal assessment research will need to address. Methods and analysis: The review will follow the PRISMA-ScR reporting guideline and the Joanna Briggs Institute methodology for scoping reviews. We will search PubMed/MEDLINE, Embase, Web of Science Core Collection, CINAHL Complete and PsycINFO from database inception to 31 December 2025. Eligible studies will recruit children aged 0 to 18 years in perioperative or analogous procedural settings, and will report both a behavioural anxiety measure and at least one concurrent physiological stress indicator. The primary analysis will focus on perioperative anaesthesia induction. Procedural sedation, venipuncture and dental contexts will be analysed as a separate secondary stratum. Premedication exposure, regular home psychoactive medication use (including cannabinoids) and the time gap between behavioural and physiological sampling will be extracted as prespecified confounders. Findings will be synthesised narratively following the Synthesis Without Meta-analysis reporting guideline. Ethics and dissemination: Ethical approval is not required because the review uses only published literature.
The paper
Citation
Guo S, Liu H, Wang L, Zhang H Physiological–behavioural discordance in paediatric perioperative anxiety assessment: a scoping review protocol. BMJ Open (2026). PubMed 42716682 · DOI
Limitations the authors noted
Protocol only; no results yet available. Heterogeneity in populations, settings and measurement methods may preclude meta-analysis. Polyvagal Theory premises are contested and not treated as established fact by the authors.
In practice
Why this matters
This protocol establishes only that the review is planned and how it will be conducted, not that children who look calm are actually under hidden stress. Any value for clinicians depends on what the completed review finds and on later studies that test whether combining behaviour and body measures improves care. It leaves open whether these measures are reliable enough for routine use.
Frequently asked questions
Clinical Questions & Answers
What did this study show regarding cannabinoids for Anxiety?
This is a plan for a future review, so it has no results yet. It sets out how the team will search the medical literature and what they will look for.
How does Dr. Benjamin Caplan interpret these results for clinical practice?
This protocol establishes only that the review is planned and how it will be conducted, not that children who look calm are actually under hidden stress. Any value for clinicians depends on what the completed review finds and on later studies that test whether combining behaviour and body measures improves care. It leaves open whether these measures are reliable enough for routine use.
What study limitations or clinical safeguards should patients keep in mind?
Protocol only; no results yet available. Heterogeneity in populations, settings and measurement methods may preclude meta-analysis. Polyvagal Theory premises are contested and not treated as established fact by the authors.
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Condition: Anxiety Condition: Child behavior
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Reviewed by Dr. Caplan on October 14, 2026.
This page is general education about a published study. It is not medical advice and does not create a doctor-patient relationship. For care specific to you, book a consultation.
