Related Experiment Video
Updated: Jun 21, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Evaluation of emergence delirium in Asian children using the Pediatric Anesthesia Emergence Delirium Scale
1Department of Pediatric Anesthesia, KK Women's and Children's Hospital, Singapore. clbong1@gmail.com
Insights
Emergence delirium (ED) affects about 10% of healthy Asian children after day surgery. Young age, poor induction compliance, no intraoperative fentanyl, and rapid awakening predict ED, with a PAED Score of 10 or higher indicating significant cases.
Area of Science:
- Pediatric Anesthesiology
- Postoperative Care
- Clinical Assessment Tools
Background:
- Emergence delirium (ED) is a frequent complication in pediatric patients recovering from general anesthesia.
- ED complicates postanesthetic care, posing challenges for monitoring and potentially endangering the child.
- A lack of standardized assessment tools previously hindered ED research.
Purpose of the Study:
- To evaluate the incidence of ED in healthy Asian children undergoing outpatient surgery.
- To assess the utility of the Pediatric Anesthesia Emergence Delirium (PAED) Scale in grading emergence behavior.
- To identify predictive factors for ED in this population.
Main Methods:
- Prospective observational study including 316 children aged 2-12 years undergoing elective outpatient surgery.
- No premedication was administered; induction behavior was assessed using the induction compliance checklist.
- Emergence behavior was recorded using the PAED Scale, with separate clinical agitation assessments.
Main Results:
- The incidence of ED, defined by a PAED Score >=10, was 10.4% (33 children).
- A PAED Score >=10 demonstrated high accuracy (AUC 0.98) in discriminating clinical agitation.
- Predictive factors for ED included young age, poor induction compliance, lack of intraoperative fentanyl, and rapid time to awakening.
Conclusions:
- The incidence of clinically significant ED is approximately 10% in healthy, unpremedicated Asian children undergoing day surgery.
- Young age, poor induction compliance, lack of intraoperative fentanyl, and rapid awakening are significant risk factors for ED.
- A PAED Scale score of 10 or higher is an effective cutoff for identifying clinically significant ED.
Background:
Emergence delirium (ED) is a common problem in children recovering from general anesthesia. ED causes disruption in the postanesthetic care unit, making nursing and monitoring more difficult, and is potentially dangerous to the child. The greatest hindrance to understanding ED was the lack of a standardized tool to assess it. The Pediatric Anesthesia Emergence Delirium (PAED) Scale was recently described to measure the degree of ED in children. In this prospective observational study, we sought to evaluate the incidence of ED by grading emergence behavior using the PAED Score in healthy Asian children undergoing outpatient surgery.
Methods:
Three hundred sixteen children aged 2-12 years undergoing general anesthesia for elective outpatient surgery were included. No premedication was administered. Induction behavior was graded using the induction compliance checklist, and the presence of any excitation on induction documented. Emergence behavior was recorded using the PAED Scale, and the children were separately assessed for clinical agitation.
Results:
One hundred and thirty-six children (43%) had PAED Scores >0 and 33 (10.4%) had PAED Scores of >or=10. Only 28 children (8.9%) had clinical agitation consistent with ED, the rest were agitated for other reasons. A score of >or=10 on the PAED Scale was the best discriminator between presence and absence of clinical agitation. The area under the receiver operating characteristic curve for PAED Score of >or=10 was 0.98, with a true-positive rate (sensitivity) of 0.85 and a false-positive rate (1-specificity) of 0.041. Four factors were found to be predictive of ED. These include young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening.
Conclusions:
The incidence of ED is approximately 10% in our population of healthy, unpremedicated Asian children undergoing day surgery. Young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening were predictive risk factors for ED in our population. A PAED Score of >or=10 was correlated with clinically significant ED and appeared to be the ideal cutoff score for ED.
