Russell PSS, Mammen PM, Shankar SR, Viswanathan SA, Rebekah G, Russell S, Earnest R, Chikkala SM. Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis. World J Clin Pediatr 2022; 11(2): 196-205 [PMID: 35433300 DOI: 10.5409/wjcp.v11.i2.196]
Corresponding Author of This Article
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
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
There are various measures to identify emergence delirium (EmD) among children and adolescents as they recover from anesthesia. Pediatric Anesthesia Emergence Delirium Scale (PAEDS) is one such measure and has been found to have varying accuracy for diagnosing EmD.
Research motivation
The diagnosis of EmD is often missed or misdiagnosed. This can result in significant morbidity. The widely used PAEDS across the world has been proven to have the ability of early identification of EmD.
Research objectives
The aims of this meta-analysis were to document the summary global and specific diagnostic accuracy parameters of PAEDS, diagnostic accuracy for various diagnostic threshold scores of the measure, and factors associated with these summary parameters of PAEDS in diagnosing EmD.
Research methods
Nine studies were included in the analysis following the PRISMA guidelines. We used the summary area under the receiver operating characteristic curve, with a random effects model, to summarize the global diagnostic accuracy of PAEDS along with its diagnostic odds ratio, sensitivity, and specificity.
Research results
The area under the SROC was 0.97 (95%CI: 95-98%). The 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.
Research conclusions
The authors have established the summary global diagnostic accuracy of PAEDS for EmD among children and adolescents.
Research perspectives
The PAEDS could be used for diagnosing EmD among children and adolescents. The specific diagnostic cut-off scores have to be further studied.
