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Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale
1St. Michael's Hospital, Department of Anesthesia, 30 Bond Street, Toronto, Ontario, Canada. sikichn@smh.toronto.on.ca
Insights
The Pediatric Anesthesia Emergence Delirium (PAED) scale is a reliable and valid tool for measuring emergence delirium in children. This new scale aids in assessing post-anesthesia behavior and improving pediatric care.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Clinical Assessment Tools
Background:
- Emergence delirium is a common post-anesthesia complication in children.
- Existing measurement tools lack reliability and validity for pediatric populations.
- The Pediatric Anesthesia Emergence Delirium (PAED) scale was developed to address this gap.
Purpose of the Study:
- To develop and evaluate the Pediatric Anesthesia Emergence Delirium (PAED) scale.
- To establish the reliability and validity of the PAED scale in children.
- To provide a standardized method for assessing emergence delirium.
Main Methods:
- A list of behavioral items was compiled and evaluated for content validity and statistical significance.
- The final PAED scale consists of five items, each scored from 1 to 4.
- Reliability and validity were assessed in 50 children using established hypotheses and sensitivity analysis.
Main Results:
- The PAED scale demonstrated high internal consistency (0.89) and reliability (0.84).
- Validity was supported by negative correlations with age and time to awakening, and higher scores after sevoflurane compared to halothane.
- The scale showed a sensitivity of 0.64 for detecting emergence delirium.
Conclusions:
- The Pediatric Anesthesia Emergence Delirium (PAED) scale is a reliable and valid instrument.
- The PAED scale can be effectively used to measure emergence delirium in pediatric patients.
- This validated scale will aid clinicians in managing post-anesthetic care.
Background:
Emergence delirium has been investigated in several clinical trials. However, no reliable and valid rating scale exists to measure this phenomenon in children. Therefore, the authors developed and evaluated the Pediatric Anesthesia Emergence Delirium (PAED) scale to measure emergence delirium in children.
Methods:
A list of scale items that were statements describing the emergence behavior of children was compiled, and the items were evaluated for content validity and statistical significance. Items that satisfied these evaluations comprised the PAED scale. Each item was scored from 1 to 4 (with reverse scoring where applicable), and the scores were summed to obtain a total scale score. The degree of emergence delirium varied directly with the total score. Fifty children were enrolled to determine the reliability and validity of the PAED scale. Scale validity was evaluated using five hypotheses: The PAED scale scores correlated negatively with age and time to awakening and positively with clinical judgment scores and Post Hospital Behavior Questionnaire scores, and were greater after sevoflurane than after halothane. The sensitivity of the scale was also determined.
Results:
Five of 27 items that satisfied the content validity and statistical analysis became the PAED scale: (1) The child makes eye contact with the caregiver, (2) the child's actions are purposeful, (3) the child is aware of his/her surroundings, (4) the child is restless, and (5) the child is inconsolable. The internal consistency of the PAED scale was 0.89, and the reliability was 0.84 (95% confidence interval, 0.76-0.90). Three hypotheses supported the validity of the scale: The scores correlated negatively with age (r = -0.31, P <0.04) and time to awakening (r = -0.5, P <0.001) and were greater after sevoflurane anesthesia than halothane (P <0.008). The sensitivity was 0.64.
Conclusions:
These results support the reliability and validity of the PAED scale.
