Risk prediction models for emergence delirium in paediatric general anaesthesia: a systematic review

Maria-Alexandra Petre; Bibek Saha; Shugo Kasuya; Marina Englesakis; Nan Gai; Arie Peliowski; Kazuyoshi Aoyama

doi:10.1136/bmjopen-2020-043968

Risk prediction models for emergence delirium in paediatric general anaesthesia: a systematic review

BMJ Open. 2021 Jan 6;11(1):e043968. doi: 10.1136/bmjopen-2020-043968.

Authors

Maria-Alexandra Petre¹, Bibek Saha², Shugo Kasuya³, Marina Englesakis⁴, Nan Gai⁵, Arie Peliowski⁵, Kazuyoshi Aoyama^{6

7}

Affiliations

¹ Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
² John A Burns School of Medicine at University of Hawai'i at Mānoa, Honolulu, Hawaii, USA.
³ Department of Anesthesia and Critical Care Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
⁴ Library and Information Services, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Anesthesia and Pain Medicine, Hospital of Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Anesthesia and Pain Medicine, Hospital of Sick Children, University of Toronto, Toronto, Ontario, Canada kazu.aoyama@utoronto.ca.
⁷ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.

Abstract

Objectives: Emergence delirium (ED) occurs in approximately 25% of paediatric general anaesthetics and has significant adverse effects. The goal of the current systematic review was to identify the existing literature investigating performance of predictive models for the development of paediatric ED following general anaesthesia and to determine their usability.

Design: Systematic review using the Prediction model study Risk Of Bias Assessment Tool (PROBAST) framework.

Data sources: Medline (Ovid), PubMed, Embase (Ovid), Cochrane Database of Systematic Reviews (Ovid), Cochrane CENTRAL (Ovid), PsycINFO (Ovid), Scopus (Elsevier) and Web of Science (Clarivate Analytics), ClinicalTrials.gov, International Clinical Trials Registry Platform and ProQuest Digital Dissertations and Theses International through 17 November 2020.

Eligibility criteria for selecting studies: All randomised controlled trials and cohort studies investigating predictive models for the development of ED in children undergoing general anaesthesia.

Data extraction and synthesis: Following title, abstract and full-text screening by two reviewers, data were extracted from all eligible studies, including demographic parameters, details of anaesthetics and performance characteristics of the predictive scores for ED. Evidence quality and predictive score usability were assessed according to the PROBAST framework.

Results: The current systematic review yielded 9242 abstracts, of which only one study detailing the development and validation of the Emergence Agitation Risk Scale (EARS) met the inclusion criteria. EARS had good discrimination with c-index of 0.81 (95% CI 0.72 to 0.89). Calibration showed a non-significant Homer-Lemeshow goodness-of-fit test (p=0.97). Although the EARS demonstrated low concern of applicability, the high risk of bias compromised the overall usability of this model.

Conclusions: The current systematic review concluded that EARS has good discrimination performance but low usability to predict ED in a paediatric population. Further research is warranted to develop novel models for the prediction of ED in paediatric anaesthesia.

Prospero registration number: CRD42019141950.

Keywords: Delirium & cognitive disorders; Paediatric anaesthesia; emergence delirium.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Anesthesia, General / adverse effects*
Bias
Child
Cognition / drug effects*
Cognition Disorders / chemically induced
Emergence Delirium / chemically induced*
Emergence Delirium / diagnosis
Humans
Risk Assessment
Surgical Procedures, Operative