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Online ISSN 1827-1596
Blankespoor R. J. 1, Janssen N. J. J. F. 2, Wolters A. M. H. 1, Van Os J. 3, 4, Schieveld J. N. M. 1
1 Department of Psychiatry, MUMC, Maastricht, the Netherlands;
2 Mutsaersstichting Child and Adolescent Psychiatric Hospital, Venlo, The Netherlands;
3 Department of Psychiatry and Psychology, European Graduate School of Neuroscience, SEARCH, MUMC, Maastricht, the Netherlands;
4 Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK
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.
CONCLUSION: 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.