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Development of the Pediatric Scale for Quality of Recovery (PedSQoR)
Cameron Graydon1, Paul A Stricker2, Stephen Kelleher3
1Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Australia.
Insights
A new 20-item Pediatric Scale for Quality of Recovery was developed to measure children's physical and psychologic recovery after surgery. This patient-centered tool is crucial for clinical trials and quality improvement in pediatric care.
Area of Science:
- Pediatric Surgery
- Patient-Centered Outcomes
- Health Outcomes Research
Background:
- Reliable patient-centered outcome metrics are essential for assessing recovery quality in clinical settings.
- Current assessment tools for pediatric quality of recovery are limited.
- This study aimed to develop a novel scale for pediatric quality of recovery.
Purpose of the Study:
- To develop and validate a patient-centered scale to measure the quality of recovery in pediatric patients.
- To create a holistic measure of physical, emotional, and psychologic recovery post-surgery.
- To establish a standardized tool for pediatric perioperative research and quality improvement.
Main Methods:
- A mixed-methods approach combining literature review and expert Delphi panel consensus.
- Semistructured interviews with pediatric patients and families to identify key recovery themes.
- Pilot testing of a questionnaire on 1,162 children undergoing elective surgery in the US and Australia.
Main Results:
- Literature search yielded 41 instruments and 216 recovery-related questions.
- Delphi process reduced items to 50; interviews confirmed expert-identified domains.
- Factor analysis of 50-item questionnaire resulted in the 20-item Pediatric Scale for Quality of Recovery.
Conclusions:
- The Pediatric Scale for Quality of Recovery is a 20-item questionnaire for holistic assessment of pediatric recovery.
- Developed with patient and family input, it focuses on physical, emotional, and psychologic aspects.
- Expected to become a standard endpoint for pediatric perioperative trials and quality improvement initiatives upon further validation.
Background:
Measuring the quality of a patient's recovery is vital, and reliable patient-centered outcome metrics are needed for clinical investigations and quality improvement. Currently, assessment tools to measure quality of recovery in pediatric patients are lacking. This study aimed to develop a scale to assess the quality of recovery construct in pediatric patients.
Methods:
Using a mixed-methods investigative model, item generation was achieved using two complementary approaches. First, a comprehensive review of the literature identified tools and questions that assessed the endpoints relevant to recovery in children. Questions were categorized and then assessed by an expert Delphi panel who determined the most significant domains and items to be included. Concurrently, semistructured interviews were conducted with patients and their families to identify themes related to recovery that were important to patients and families. The resulting pilot questionnaire was administered to patients and their families presenting for elective surgery in the United States and Australia.
Results:
The literature search identified 41 instruments, comprising 216 questions relevant to recovery. After the initial Delphi round, the item list was reduced to 91 questions, and then to 50 questions after the second round. The themes identified in the semistructured interviews aligned with domains considered important by a panel of experts. A 50-item questionnaire was administered to 1,162 children at multiple timepoints after surgery. Item reduction and factor analysis resulted in the 20-item Pediatric Scale for Quality of Recovery that assesses the domains relevant to physical and psychologic recovery.
Conclusions:
The Pediatric Scale for Quality of Recovery scale is a 20-item questionnaire designed to provide a holistic representation of a child's physical, emotional, and psychologic recovery after surgery and anesthesia. It was developed and validated with consumer involvement and a strong patient-centered focus. Once further validation has been established, it is expected to become a standardized endpoint in pediatric perioperative trials and quality improvement projects.
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