Background and goal of the study
The Pediatric Anesthesia Emergence Delirium (PAED) scale is considered the golden standard to assess children’s emergence delirium (ED). The aim of this study is to validate a new scale to assess postoperative ED in children taking into account certain signs in eyes and movement (1,2). 

Materials and methods
After IRB approval, a prospective cohort study was carried out as part of an ongoing study investigating ED after anesthesia dental care. 

Instruments:
a. the new short Additional Structured Behavior Observation (ASBO) consists of 5 items: 1. purposeful handling; 2. eyes averted or stare; 3. no reaction to stimuli (verbal, tactile); 4. the child is aware of its surroundings; 5. the child is consolable. Each question can be answered by yes or no (score range 0 – 5); b. the PAED scale to assess ED.  Both scales were measured by trained observers at 5 min, 10 min, 15 min and at 20 min after awaking.

Statistics: 
a. concurrent validity between ASBO and PAED were computed (Spearman rank correlation); b. discriminant validity: receiver operating characteristic (ROC) curve was calculated to determine a cut-off score to assess ED with ASBO, with as reference a PAED score > 12; c. construct validity: calculate the trend of the ASBO scores over time (Friedman’s rank test).     

Results and discussion
The cohort included 107 children (45 % girls) with mean age of 68.5 (months), SD ± 19.7. The correlations between ASBO and PAED scores (r = .83; P <.0001) are strong. ROC analysis for ASBO (area under the curve [AUC] = .93; [95% CI: .91-.95], P <.0001) showed a score of  > 1 on the ASBO to assess ED. Using this cut-off, the  sensitivity was 89.6% and the specificity 86.1%. Decreased ASBO scores over time confirmed construct validity 
(P = .002).

Conclusion
This new ASBO is a new easy to use, valid and clinically relevant tool to assess ED in children after surgery.
 
References
1. Sikich N, Lerman J. Anesthesiology. 2004;100(5):1138-45.
2. Malarbi S, Stargatt R, Howard K, Davidson A. Paediatric anaesthesia. 2011;21(9):942-50

The additional structured behavior observation, a new tool to assess emergence delirium in children after surgery