Validation of an emoji-based Visual Facial Anxiety Scale (VFAS) for assessing preoperative anxiety: A comparison to the ‘gold standard’ State- Trait Anxiety Inventory (STAI-S) scale

Author(s): Roya Yumul, Ofelia Loani Elvir-Lazo, Paul F. White, Xiao Zhang, Waguih William IsHak, David Chernobylsky, Omar Durra, Hamed Sadeghipour

Background: This observational, prospective cohort study was designed to assess the reliability and validity of an emoji-based Visual Facial Anxiety Scale (VFAS) for assessing preoperative (state) anxiety compared to the state anxiety subscale (STAI-S) of the ‘gold standard’ state-trait anxiety inventory (STAI) scale.

Methods: 293 adult patients undergoing elective surgical procedures were recruited to participate in a study performed in the preoperative evaluation area. The two anxiety scales were administered in a random order to assess the patient’s level of preoperative anxiety. In addition, to the time required to perform each evaluation, both the patients and anesthesiologists were asked to choose the preferred anxiety assessment tool.

Main Results: There was a highly significant correlation (p<0.0001) between the VFAS (rs=0.552) and the STAI-S anxiety scores. The Cronbach alpha-value was 0.715, indicating that VFAS is a reliable measure with good internal consistency for assessing anxiety. However, the STAI-S evaluation time (247± 55 sec) was significantly longer than the evaluation time for the VFAS (7.3 ± 1.6 sec). Compared to the STAI-S, the VFAS was preferred by 68% of the study patients for assessing their level of preoperative anxiety.

Conclusions: The VFAS scale was highly correlated (r=0.552) with the ‘gold standard’ STAI-S for assessing acute (state) anxiety while requiring significantly less time to complete.