Post-hoc revision of the Pediatric Anesthesia Emergence Delirium rating scale: clinical improvement of a bedside-tool?

R. J. Blankespoor, N. J. J. F. Janssen, A. M. H. Wolters, J. Van Os, J. N. M. Schieveld*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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. (Minerva Anestesiol 2012;78:896-900)
Original languageEnglish
Pages (from-to)896-900
JournalMinerva Anestesiologica
Issue number8
Publication statusPublished - Aug 2012


  • Intensive Care Units, Pediatric
  • Delirium
  • Psychometrics


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