• emergence delirium
• instrument development
• pediatric anesthesia
• postoperative behavioral changes

• Forskningsrådet i Sydöstra Sverige
• Department of Research, Region Kalmar County
• 931752 the Medical Research Council of Southeast Sweden
• 968263 the Medical Research Council of Southeast Sweden
• 995332 the Medical Research Council of Southeast Sweden

• Humans
• Male
• Female
• Middle Aged
• Adult
• Psychomotor Agitation
• Recovery Room
• Anesthesia Recovery Period
• Retrospective Studies
• Risk Factors
• Aged
• Anesthesia, General/adverse effects

• Electroencephalogram
• Electroencephalography
• Emergence agitation
• Emergence delirium
• Emergence excitement
• Pediatric anesthesia
• Post operative delirium.

• Emergence delirium
• General anesthesia
• Pediatric delirium
• Pediatric nursing care

• Humans
• Anesthesia, General/adverse effects
• Emergence Delirium/epidemiology
• Prevalence
• Child
• Risk Factors
• Global Health
• Female
• Male

• Critical care
• Delirium
• Intensive care unit
• Pediatric
• Systematic review

• Humans
• Child
• Delirium/therapy
• Delirium/prevention & control
• Emergence Delirium/therapy
• Adolescent
• Child, Hospitalized/psychology

• Children
• Emergence delirium
• PAED score
• Postoperative outcomes
• Postoperative recovery

• Child
• Female
• Humans
• Male
• Anesthesia Recovery Period
• Anesthesia, General/adverse effects
• Anesthesia, Inhalation/adverse effects
• Emergence Delirium/epidemiology
• Emergence Delirium/prevention & control
• Emergence Delirium/etiology
• Prospective Studies
• Sevoflurane
• Child, Preschool

Delirium is a disturbance of attention and awareness that represents a change from baseline mental status. Accurate diagnosis of delirium is of paramount importance to improving the management of pediatric delirium in the intensive care unit. Despite ongoing education, inconsistencies in delirium assessments occur. Here, we aimed to determine the extent of the problem and increase compliance with delirium assessments.

We collected preintervention data to assess baseline compliance of delirium assessments in the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU) at Monroe Carell Jr Children’s Hospital at Vanderbilt in November 2020. We executed 2 Plan-Do-Study-Act cycles with different interventions and collected data after each and approximately 1 year after the interventions. The first intervention consisted of virtual lectures on delirium assessments for the nursing staff. The second intervention included an educational handout and a new electronic medical record documentation tool.

Five hundred five individual nurse-patient encounters were assessed and collected throughout the project. The mean compliance of delirium documentation before the interventions was 52.5%. Target compliance after interventions was 70%. Mean compliance was 70% after cycle 1, 78% after cycle 2, and 86% in March 2022.

Using pre- and postintervention data from chart reviews and nurse interviews regarding delirium screenings, we found that interventions targeting nurse education and EMR flowsheet improved compliance with delirium assessment and documentation in the PICU and PCICU. Future work should focus on assessing the clinical implications of this project in diagnosing and treating delirium.

Delirium is a common postoperative complication in elderly hip fracture patients that seriously affects patients’ lives and health, and early delirium risk prediction, and targeted measures can significantly reduce the incidence of delirium. The purpose of this study was to develop and validate a nomogram for the prediction of postoperative delirium (POD) in elderly hip fracture patients. A total of 328 elderly patients with hip fractures enrolled retrospectively in department 1 of our hospital were randomly divided into the training set (n = 230) and the internal validation set (n = 98). The least absolute shrinkage and selection operator (LASSO) regression analysis was used for feature variable selection, and multivariate logistic regression with a backward stepwise method was used to construct a nomogram in the training set. The discrimination efficacy and calibration efficacy of the nomogram were evaluated through the receiver operating characteristic (ROC) curve and calibration curve, respectively. The clinical usefulness was estimated through decision curve analysis (DCA) and clinical impact curve (CIC) analysis. Another validation set from department 2 of our hospital, containing 76 elderly patients with hip fractures, was used for external validation of the nomogram. A total of 43 (13.1%) and 12 (15.8%) patients had POD in department 1 and department 2, respectively. The nomogram was constructed by three predictors, including dementia, chronic obstructive pulmonary disease (COPD), and albumin level. The nomogram showed good discrimination efficacy and calibration efficacy, with the AUC of 0.791 (95% CI, 0.708–0.873), 0.820 (95% CI, 0.676–0.964), and 0.841 (95% CI, 0.717–0.966) in the training set, the internal validation set, and the external validation set, respectively. Both DCA and CIC demonstrated that this nomogram has good clinical usefulness. The nomogram constructed by dementia, COPD, and albumin level can be conveniently used to predict POD in patients with elderly hip fractures.

• Key Science and Technology Program of Shaanxi Province

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.

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

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.

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.

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

• Anesthesia
• Children
• Emergence delirium
• Diagnostic accuracy
• Measure
• Meta-analysis

• Anesthesia
• Child
• Child, Preschool
• Dexmedetomidine/adverse effects
• Emergence Delirium/chemically induced
• Emergence Delirium/prevention & control
• Humans
• Hypnotics and Sedatives/adverse effects
• Magnetic Resonance Imaging
• Outpatients

• child behavior checklist
• emergence delirium
• general anesthesia
• posthospital change
• preoperative anxiety
• preschool children

• Anesthesia Recovery Period
• Anesthesia, General/adverse effects
• Child
• Child, Preschool
• Emergence Delirium/epidemiology
• Hospitals
• Humans
• Patient Discharge

• 2018R1C1B502975413 Ministry of Science and ICT