Pediatric Emergence Delirium Following General Anesthesia for Orthopedic Surgery: Psychometric Properties of the Traditional Chinese Version of the Cornell Assessment of Pediatric Delirium.

PURPOSE: Children undergoing general anesthesia have a considerably high risk of emergence delirium (ED), which is a long-underestimated condition. The purpose of this study was to translate and validate the CAPD into traditional Chinese (CAPD-TC), for use with pediatric patients undergoing general anesthesia for elective orthopedic surgery.

DESIGN

A prospective observational study.

METHODS

Children who underwent elective orthopedic surgery and were admitted to postanesthesia care units in Taiwan between October 2023 and July 2024 were included. ED was evaluated using the traditional Chinese version of the Cornell Assessment of Pediatric Delirium (CAPD-TC) concerning delirium diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision. We tested construct validity with confirmatory factor analysis and assessed known-group validity by comparing CAPD-TC scores across age (preschool vs school age) and pain severity (mild vs moderate-to-severe). Internal reliability, inter-rater reliability, and diagnostic accuracy were also evaluated using receiver operating characteristic curve analysis.

FINDINGS: A total of 200 children (aged 2 to 12 years, mean age: 9.2 years) were included. In accordance to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision criteria, 34.5% developed ED. Confirmatory factor analysis revealed a three-factor structure with an acceptable model fit. CAPD-TC revealed high known-group validity for pain severity and age with reliability analysis of Cronbach's α of 0.83 and inter-rater reliability of 0.88. Receiver operating characteristic analysis identified an optimal cutoff of 11 points and an area under the curve of 0.95, sensitivity of 97.0%, and specificity of 76.0%.

CONCLUSIONS

The CAPD-TC effectively detects ED during the anesthesia recovery phase in children undergoing elective orthopedic surgery. Our findings indicate CAPD-TC as a reliable tool for timely ED assessment.