Ringblom Jenny, Wåhlin Ingrid, Proczkowska Marie, Korhonen Laura, Årestedt Kristofer
Center for Social and Affective Neuroscience and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Department of Anesthesiology and Intensive Care, Region Kalmar County, Kalmar, Sweden.
Paediatr Anaesth. 2025 Feb;35(2):155-162. doi: 10.1111/pan.15046. Epub 2024 Nov 29.
Emergence delirium is a well-known and common problem in children recovering from anesthesia. The five-item Pediatric Anesthesia Emergence Delirium scale is one of the most commonly used instruments for assessing this condition, but the scale has been questioned regarding its latent structure, i.e., whether its items cover just one underlying construct. It has been suggested that the scale's first three items might identify emergence delirium better than the last two.
The aim of this study was to evaluate the measurement properties of the Pediatric Anesthesia Emergence Delirium scale with a focus on its latent structure and cutoff scores, using appropriate statistical methods for ordinal data.
A total of 350 children under 7 years of age, undergoing adenoidectomy, with or without additional tonsillotomy or minor procedures like paracentesis, tongue-tie release, or cerumen removal, were enrolled in the study. At the recovery unit, emergence delirium and pain were registered.
The confirmatory factor analyses demonstrated that the two-factor model, including emergence delirium-specific behaviors (first three items) and emergence delirium-nonspecific behaviors (last two items), established an excellent model fit according to the χ goodness-of-fit statistics, Root Mean Square Error of Approximation, Comparative Fit Index, Tucker-Lewis Index, and Standardized Root Mean Square Residual. The ordinal alpha of 0.98 and the ordinal omega of 0.96 supported the internal consistency reliability of the emergence delirium-specific behaviors. The convergent validity was supported due to a strong correlation between emergence delirium-nonspecific behaviors and the Face, Legs, Activity, Cry, and Consolability scale. The receiver-operating characteristic curve analyses resulted in two tentative cutoff scores for emergence delirium-specific behaviors¸ ≥ 6 and ≥ 8.
The Pediatric Anesthesia Emergence Delirium scale's first three items are a more valid and reliable measure of emergence delirium than its original five items.
苏醒期谵妄是儿童麻醉苏醒过程中一个广为人知的常见问题。五项小儿麻醉苏醒期谵妄量表是评估该状况最常用的工具之一，但该量表的潜在结构受到质疑，即其条目是否仅涵盖一个潜在结构。有人提出该量表的前三项可能比后两项能更好地识别苏醒期谵妄。
本研究旨在使用适用于有序数据的统计方法，评估小儿麻醉苏醒期谵妄量表的测量特性，重点关注其潜在结构和截断分数。
本研究共纳入350名7岁以下接受腺样体切除术的儿童，部分儿童还接受了扁桃体切除术或穿刺术、舌系带松解术或耵聍清除术等小型手术。在恢复室，记录苏醒期谵妄和疼痛情况。
验证性因素分析表明，两因素模型，包括苏醒期谵妄特异性行为（前三项）和苏醒期谵妄非特异性行为（后两项），根据卡方拟合优度统计量、近似均方根误差、比较拟合指数、塔克 - 刘易斯指数和标准化均方根残差，建立了良好的模型拟合。苏醒期谵妄特异性行为的有序α系数为0.98，有序ω系数为0.96，支持了其内部一致性信度。由于苏醒期谵妄非特异性行为与面部、腿部、活动、哭闹和安慰量表之间存在强相关性，支持了收敛效度。受试者工作特征曲线分析得出苏醒期谵妄特异性行为的两个暂定截断分数，分别为≥6和≥8。
小儿麻醉苏醒期谵妄量表的前三项比原来的五项能更有效、可靠地测量苏醒期谵妄。
