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Behavioral changes after hospital discharge in preschool children experiencing emergence delirium after general
Jonghae Kim1, Sung Hye Byun2, Jun Won Kim3
1Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Daegu, Korea.
Insights
Emergence delirium in children after surgery is linked to more significant behavioral issues post-discharge. High preoperative anxiety and delirium scores predict these negative changes, highlighting the need for monitoring.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Postoperative Care
Background:
- Emergence delirium is a common postoperative behavioral change in children.
- The long-term behavioral impact of emergence delirium after hospital discharge remains unclear.
Purpose of the Study:
- To investigate the association between emergence delirium and posthospital behavioral changes in preschool-aged children.
- To identify risk factors for negative behavioral alterations following surgery.
Main Methods:
- An observational study included 100 preschoolers (2-7 years) undergoing elective surgery.
- Emergence delirium was assessed using the Pediatric Anesthesia Emergence Delirium score (PAED score).
- Posthospital behavior was evaluated using the Child Behavior Checklist (CBCL) one week after discharge.
Main Results:
- Children with emergence delirium (n=58) exhibited significantly higher CBCL scores compared to those without (n=42).
- Increased preoperative anxiety and higher peak delirium-specific scores were associated with greater posthospital behavioral changes.
- Pain-related scores, surgery type, premedication, and age did not predict posthospital behavioral changes.
Conclusions:
- Emergence delirium is associated with more severe behavioral changes one week after surgery.
- High preoperative anxiety and emergence delirium scores are predictive of posthospital behavioral disturbances.
Background:
Emergence delirium is well known as early postoperative behavioral change after general anesthesia. However, it is unclear whether children with emergence delirium have negative behavioral changes after hospital discharge.
Aim:
This observational study investigated the association between emergence delirium and posthospital behavioral changes.
Methods:
One-hundred preschoolers aged 2-7 years undergoing elective surgery were enrolled in 2 tertiary university hospitals. Preoperative anxiety level was assessed using modified Yale preoperative anxiety scale. Emergence delirium was defined via pediatric anesthesia emergence delirium score ≥12 at any time in the recovery room. We divided the delirium score into a delirium-specific score (the sum of the first 3 items: eye contact, purposeful movement, and awareness of surrounding) and a pain-related score (the sum of the last 2 items: restlessness and inconsolability). High delirium scores represent severe emergence delirium. Posthospital behavioral changes were assessed by a change in Child Behavior Checklist 1.5-5 scores before and 1 week after surgery. The primary outcome was the total behavior checklist scores 1 week after surgery. Multiple linear regression was performed to identify risk factors for posthospital behavioral changes.
Results:
Children with emergence delirium (n = 58) had higher postoperative behavior checklist scores than children without emergence delirium (n = 42) [mean (SD), 22.8 (17.5) vs. 14.0 (12.1); mean difference (95% CI), 8.8 (1.5-16.2)]. Increases in preoperative anxiety level [regression coefficient (b) (95% CI) =0.241 (0.126-0.356)] and peak delirium-specific score [b = 0.789 (0.137-1.442)] were associated with an increase in behavior checklist score 1 week after surgery, while pain-related score, type of surgery, premedication, and age were not.
Conclusion:
Children with emergence delirium developed more severe behavior changes 1 week after surgery than those without emergence delirium. High preoperative anxiety level and emergence delirium scores were associated with posthospital behavioral changes.
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