Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2022; 11(2): 196-205
Published online Mar 9, 2022. doi: 10.5409/wjcp.v11.i2.196
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
Paul Swamidhas Sudhakar Russell, Priya Mary Mammen, Satya Raj Shankar, Shonima Aynipully Viswanathan, Sushila Russell, Richa Earnest, Swetha Madhuri Chikkala, Child and Adolescent Psychiatry Unit, Christian Medical College, Vellore 632 002, Tamil Nadu, India
Grace Rebekah, Department of Biostatistics, Christian Medical College, Vellore 632 002, Tamil Nadu, India
Author contributions: Russell PSS and Mammen PM conceived and designed the study; Chikkala SM and Earnest R did the literature search and collected the data; Mammen PM and Shankar SR extracted the data; Viswanathan SA and Russell S appraised the quality of the studies; Mammen PM resolved the conflicts in data extraction and quality appraisal; Russell PSS and Rebekah G did the statistical analyses; all authors contributed to the writing and approval of the final manuscript.
Conflict-of-interest statement: All authors declare that there are no any conflicts of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paul Swamidhas Sudhakar Russell, DNB, MBBS, MD, Full Professor, Child and Adolescent Psychiatry Unit, Christian Medical College, Bagayam, Vellore 632 002, Tamil Nadu, India. russell@cmcvellore.ac.in
Received: March 19, 2021
Peer-review started: March 19, 2021
First decision: May 14, 2021
Revised: May 27, 2021
Accepted: February 9, 2022
Article in press: February 9, 2022
Published online: March 9, 2022
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; I2 = 92.93%) and 0.94 (95%CI: 0.89-0.97; I2 = 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, Emergence delirium, Diagnostic accuracy, Measure, Meta-analysis

Core Tip: Emergence delirium (EmD) is a motoric, emotional, and cognitive condition that is often seen among children or adolescents during their recovery from anesthesia. This condition is present in a sizeable portion of this age group and could result in morbidity. Many psychometrically validated measures are available to identify this post-anesthesia emergent phenomenon; one such test is the Pediatric Anesthesia Emergence Delirium scale (PAEDS). This meta-analysis documents that the diagnostic accuracy parameters are excellent for this measure. PAEDS use can significantly help diagnose EmD in post-anesthesia settings among children and adolescents.