Pediatric Anesthesia Emergence Delirium Scale: A diagnostic meta-analysis

doi:10.5409/wjcp.v11.i2.196

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World Journal of Clinical Pediatrics

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Meta-Analysis

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.

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
Processing time: 354 Days and 21.2 Hours

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.