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Effectiveness of Nurse-Led Interventions on Emergence Delirium in Pediatric Patients: A Systematic Review and
Cong-Hui Fu1, Min-Jie Ju1, Yan Li1
1Department of Critical Care Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Background:
Nurse-led interventions have demonstrated effectiveness in managing emergence delirium (ED), but there is a lack of evidence in pediatric studies.
Aim:
To systematically synthesize the evidence on the effectiveness of the nurse-led interventions on ED in pediatric patients.
Study Design:
A comprehensive literature search was conducted in PubMed, CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, and APA PsycINFO from the inception to January 13, 2025. Risk of bias was assessed by using the revised Cochrane risk-of bias tool (ROB2) and the Cochrane risk of bias in non-randomized studies-of interventions (ROBINS-I). The meta-analysis was performed using Stata16.0. The forest plots showed the overall effect of the included study.
Results:
A total of 20 studies were included, involving 2369 children, comprising 17 RCTs, 1 quasi-experimental study and 2 cohort studies. Compared with usual care, nurse-led interventions significantly reduced the incidence of ED (risk ratio [RR]: 0.50, 95% confidence interval [CI]: 0.33 to 0.77, p = 0.002, I2 = 77.2%), m-YPAS scores (weighted mean difference [WMD]: -7.67, 95% CI: -10.96 to -4.39, p = 0.000, I2 = 91.7%), PAED scores (WMD: -1.47, 95% CI: -2.35 to -0.60, p = 0.000, I2 = 91.3%), and FLACC scores (WMD: -0.97, 95% CI: -1.59 to -0.35, p = 0.000, I2 = 92.9%). However, no significant effect was observed on the length of PACU stay or the anesthesia induction compliance.
Conclusions:
Nurse-led interventions can reduce the incidence and severity of ED in children, as well as in alleviating preoperative anxiety and postoperative pain. However, more research is needed on influencing PACU length of stay and induction compliance.
Relevance To Clinical Practice:
Nurse-led interventions can be integrated into the perioperative management of children to reduce the incidence of ED. However, in clinical practice, these interventions should be flexibly adapted based on the individual differences of pediatric patients.
Trial Registration:
This study protocol was registered on PROSPERO with the registration number CRD42024601191.
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