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

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

Maria-Alexandra Petre  1 , Bibek Saha  2 , Shugo Kasuya  3 , Marina Englesakis  4 , Nan Gai  5 , Arie Peliowski  5 , Kazuyoshi Aoyama  6   7
Affiliations

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

Maria-Alexandra Petre et al. BMJ Open. .

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
PRISMA flow diagram for search and review strategy. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

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