Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis

Paul Swamidhas Sudhakar Russell; Priya Mary Mammen; Satya Raj Shankar; Shonima Aynipully Viswanathan; Grace Rebekah; Sushila Russell; Richa Earnest; Swetha Madhuri Chikkala

doi:10.5409/wjcp.v11.i2.196

Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis

World J Clin Pediatr. 2022 Mar 9;11(2):196-205. doi: 10.5409/wjcp.v11.i2.196.

Authors

Paul Swamidhas Sudhakar Russell¹, Priya Mary Mammen², Satya Raj Shankar², Shonima Aynipully Viswanathan², Grace Rebekah³, Sushila Russell², Richa Earnest², Swetha Madhuri Chikkala²

Affiliations

¹ Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India. russell@cmcvellore.ac.in.
² Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India.
³ Department of Biostatistics, Christian Medical College, Vellore 632 002, Tamil Nadu, India.

Abstract

Background: Emergence delirium (EmD) is a troublesome motoric, emotional, and cognitive disturbance associated with morbidity. It is often misdiagnosed despite being present in a substantial proportion of children and adolescents during emergence from anesthesia.

Aim: To evaluate the summary diagnostic accuracy of Pediatric Anesthesia Emergence Delirium Scale (PAEDS) for EmD among children and adolescents.

Methods: Two researchers electronically and hand searched the published literature from May 2004 to February 2021 that evaluated the diagnostic accuracy of PAEDS for EmD among children and adolescents, using appropriate terms. Two independent researchers extracted the diagnostic parameters and appraised the study quality with QUADAS-2. Overall, the diagnostic accuracy of the measures was calculated with the summary receiver operating characteristic curve (SROC), the summary sensitivity and specificity, and diagnostic odds ratio (DOR) for EmD. Various diagnostic cut-off points were evaluated for their diagnostic accuracy. Heterogeneity was analyzed by meta-regression.

Results: Nine diagnostic accuracy studies of EmD that conformed to our selection criteria and PRISMA guidelines were included in the final analysis. There was no publication bias. The area under the SROC was 0.97 (95% confidence interval [CI]: 95%-98%). Summary sensitivity and specificity were 0.91 (95%CI: 0.81-0.96; I ² = 92.93%) and 0.94 (95%CI: 0.89-0.97; I ² = 87.44%), respectively. The summary DOR was 148.33 (95%CI: 48.32-455.32). The effect size for the subgroup analysis of PAEDS cut-off scores of < 10, ≥ 10, and ≥ 12 was 3.73, 2.19, and 2.93, respectively; they were not statistically significantly different. The setting of the study and reference standard were statistically significantly related to the sensitivity of PAEDS but not specificity.

Conclusion: The PAEDS is an accurate diagnostic measure for the diagnosis of EmD among children and adolescents. Further studies should document its clinical utility.

Keywords: Anesthesia; Children; Diagnostic accuracy; Emergence delirium; Measure; Meta-analysis.