title: Post-hoc revision of the pediatric anesthesia emergence delirium rating scale: clinical improvement of a bedside-tool?
abstract: BACKGROUND
  Pediatric delirium (PD) is a severe neuropsychiatric disorder often seen at the pediatric intensive care unit (PICU). The Pediatric Anesthesia Emergence Delirium (PAED) scale assesses five behavioral items on a five-level severity scale, and is easily applicable in children. However, the five-level severity scales are rather arbitrarily anchored and subjective. This study aimed to pilot a practical and clinical improvement of the PAED by condensing the five-level scales of the five behavioral items to a more objectively anchored two- and three-point scale.
  
  
  METHODS
  Post-hoc analysis of routine data in an eight-bed PICU in a tertiary university hospital. 144 critically ill, non-electively admitted patients, aged 1-18 years, were included between November 2006 and February 2010. Scales of the five PAED-items were condensed post-hoc from five to two- and three levels of severity. Five scale properties were analyzed: 1) internal consistency; 2) item-total score correlations; 3) inter-rater agreement; 4) sensitivity and specificity; and 5) discriminative diagnostic ability.
  
  
  RESULTS
  Three-level PAED-items post-hoc displayed Cronbach's alpha of 0.86, and mean item-total score correlation was 0.71 (range 0.60 to 0.79). Inter-rater agreement was high (0.90). The most optimal cut-off was 8 (sensitivity=100%, specificity=96.7%) with an area under the curve (AUC) of 0.98. Likelihood ratio for a positive test result (LR+) was 30.3.
  
  
  CONCLUSIONS
  A three-level severity scale for the five PAED-items may be optimal to diagnose PD. Further prospective research is required to determine whether a revised PAED has adequate psychometric properties and is applicable across different clinical settings.
authors.affiliation: Department of Psychiatry, MUMC, Maastricht, the Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Blankespoor
authors.forename: N J J F
authors.initials: NJ
authors.lastname: Janssen
authors.forename: A M H
authors.initials: AM
authors.lastname: Wolters
authors.forename: J
authors.initials: J
authors.lastname: Van Os
authors.forename: J N M
authors.initials: JN
authors.lastname: Schieveld
mesh_terms: D000293:Adolescent; D000758:Anesthesia / Q000009:adverse effects*; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D003693:Delirium / Q000139:chemically induced / Q000175:diagnosis* / Q000523:psychology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems; D011594:Psychometrics / Q000379:methods*; D012372:ROC Curve