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A comparison of emergence delirium scales following general anesthesia in children
Samira A Bajwa1, David Costi, Allan M Cyna
1Department of Paediatric Anaesthesia, Women's and Children's Hospital, Adelaide, SA, Australia.
Insights
Emergence delirium (ED) in children is increasingly studied. The Pediatric Anesthesia Emergence Delirium (PAED) scale, Watcha scale, and Cravero scale showed good correlation, with PAED >12 offering improved sensitivity for ED detection.
Area of Science:
- Pediatric Anesthesiology
- Clinical Assessment Tools
- Patient Safety
Background:
- Emergence delirium (ED) is a growing concern following anesthesia with short-acting agents like sevoflurane.
- Accurate assessment of ED is crucial for pediatric patient care and safety post-anesthesia.
Purpose of the Study:
- To compare the efficacy of three scales: Pediatric Anesthesia Emergence Delirium (PAED), Watcha, and Cravero, in assessing ED in children.
- To determine the optimal scoring threshold for the PAED scale in identifying ED.
Main Methods:
- A comparative study involving 117 children under 18 years undergoing general anesthesia.
- Utilized PAED, Watcha, and Cravero scales to assess ED during the post-anesthesia care unit (PACU) stay.
- Included subjective assessment by an experienced pediatric anesthetist for validation.
Main Results:
- PAED score >=10 identified ED in 32% of children, Watcha in 26%, and Cravero in 35%.
- Twenty-one percent of patients met ED criteria across all three scales.
- Higher median scores were observed for patients with ED compared to those without across all assessment methods.
Conclusions:
- All three scales demonstrated reasonable correlation but possess individual limitations for ED assessment.
- A PAED score >12 suggests greater sensitivity and specificity for ED compared to a score >=10.
- The Watcha scale offers a simpler clinical application and potentially higher overall sensitivity and specificity.
Background:
Emergence delirium (ED) is of increasing interest since the introduction of short-acting volatiles such as sevoflurane.
Methods:
We compared the Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales for assessing the presence of ED in 117 of 118 consecutive children <18 years recovering from general anesthesia. The primary measure was the worst score for ED as assessed on each scale and for each patient during their PACU stay. An experienced anesthetist observer also made a subjective assessment of the presence of ED.
Results:
A PAED score of > or =10 detected ED in 37 children (32%), while the Watcha detected 30 (26%) and Cravero 41 (35%). Twenty-five patients (21%) fulfilled criteria for ED in all three scales as did all eight patients assessed by the experienced pediatric anesthetist observer. Median PAED scores (interquartile ranges) for patients assessed as having ED or not respectively were for Watcha, 12 (11,14), 7 (4,8); for Cravero, 11 (9,13), 7 (4,8); and for the experienced anesthetist observer, 14.5 (13.5,16.5), 7 (6,10).
Conclusions:
All three scales correlated reasonably well with each other but have individual limitations in their potential to assess whether ED is present. In the absence of developing an improved research tool to assess ED, a PAED score >12 appears to provide greater sensitivity and specificity than a PAED score > or =10. However, the Watcha scale is a simpler tool to use in clinical practice and may have a higher overall sensitivity and specificity than the other scales.
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