Identifying pediatric emergence delirium by using the PAED Scale: a quality improvement project

Area of Science:

• Anesthesiology
• Pediatric Critical Care
• Postoperative Management

Background:

• Pediatric emergence delirium presents as aberrant behavior post-surgery, risking patient and staff safety.
• The Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS) is commonly used but lacks pediatric validation.
• The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a validated tool specifically for assessing emergence delirium in children.

Purpose of the Study:

• To implement and evaluate the effectiveness and fidelity of the PAED Scale.
• To compare the PAED Scale with the LOC-RASS for identifying pediatric emergence delirium.
• To assess the incidence of pediatric emergence delirium using both scales.

Main Methods:

• Implementation of the PAED Scale in an eight-bed postanesthesia care unit.
• Comparison of PAED Scale data with LOC-RASS data (retrospective and during implementation).
• Analysis of the incidence of pediatric emergence delirium identified by each scale.

Main Results:

• Retrospective LOC-RASS identified 3% incidence of emergence delirium.
• During implementation, LOC-RASS identified 7.5% incidence.
• The PAED Scale identified a significantly higher incidence of 11.5% during implementation.

Conclusions:

• The PAED Scale appears to be a more sensitive measure for pediatric emergence delirium.
• The PAED Scale is recommended over LOC-RASS for healthcare personnel at this facility.
• Improved identification of emergence delirium can enhance pediatric postoperative safety.