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Identifying pediatric emergence delirium by using the PAED Scale: a quality improvement project
Insights
The Pediatric Anesthesia Emergence Delirium Scale (PAED) is more sensitive for detecting emergence delirium in children than the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS). This new scale is recommended for improved pediatric postoperative care.
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.
Abstract:
Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS.
