Pediatrik Anestezi Uyanma Deliryum Ölçeği’nin Türkçe versiyonunun geçerlilik ve psikometrik değerlendirmesi

Abstract

Amaç: Bu çalışmanın amacı, Pediatrik Anestezi Uyanma Deliryum (PAED) ölçeğinin Türkçeye uyarlanmış versiyonunun (PAED-T) geçerlilik, güvenilirlik ve tarama performansını değerlendirmektir. Gereç ve Yöntemler: Tek merkezli, prospektif, gözlemsel çalışmaya 2–16 yaş arası pediatrik hastalar (n=364) dâhil edildi. PAED ölçeği 0. ve 10. dakikalarda uygulandı. Yakınsama ve ayırt edici geçerlilik sırasıyla FLACC ve Modifiye Aldrete Skoru (MAS) ile incelendi. İç tutarlılık Cronbach alfa ve gerekli durumlarda ordinal omega (ω) ile değerlendirildi. Yapı geçerliliği için KMO, Bartlett testi ve varimaks rotasyonlu temel bileşenler analizi kullanıldı. Tarama performansı, deliryuma özgü bir altın standart olmayıp davranışsal bir referans ölçüt (ağrı/ajitasyon göstergesi) olarak kullanılan FLACC>3’e göre ROC analizi (AUC), duyarlılık/özgüllük, Youden’s J ve olasılık oranları (LR+/LR−) ile değerlendirildi. Bulgular: Ortalama yaş 73,4±29,8 ay; hastaların %97,3’ü erkekti. PAED-T için iç tutarlılık α=0,728–0,741 bulundu. İki faktörlü çözüm tek faktörlü modele kıyasla daha iyi performans gösterdi: ED-I (göz teması, amaca yönelik hareketler, çevrenin farkında olma; yükler 0,708–0,877; ω=0,750) ve ED-II (huzursuzluk, teselli edilememesi; yükler 0,898–0,909; ω=0,833). PAED-T ile FLACC arasında orta düzey pozitif korelasyon (ρ=0,373), MAS ile zayıf negatif korelasyon saptandı (ρ=−0,163). ROC analizinde AUC=0,794 idi; ≥10 eşik değerinde duyarlılık %87,5, özgüllük %59,4 ve LR−=0,21 bulundu. Sonuç: PAED-T, pediatrik anestezide uyanma deliryumunun taranması ve izlenmesinde geçerli ve güvenilir bir araçtır. Klinik tarama için ≥10 eşik değeri pratik görünmekle birlikte, FLACC’nin deliryuma özgü olmaması nedeniyle ROC bulguları tarama bağlamında yorumlanmalıdır

Keywords

• deliryum
• genel anestezi
• uyanma deliryumu
• pediatrik anestezi
• geçerlilik
• ROC eğrisi

Validation and psychometric evaluation of the Turkish version of the Pediatric Anesthesia Emergence Delirium Scale

Abstract

Aim: To evaluate the validity, reliability, construct structure, and screening concordance of the Turkish-adapted Pediatric Anesthesia Emergence Delirium scale (PAED-T). Material and Methods: In this single-center, prospective observational study, pediatric patients aged 2–16 years (n=364) were enrolled. The PAED scale was administered at 0 and 10 minutes. Convergent and discriminant validity were examined using the FLACC scale and the Modified Aldrete Score (MAS), respectively. Internal consistency was assessed using Cronbach’s alpha and, when appropriate, ordinal omega (ω). Construct validity was evaluated with the Kaiser–Meyer–Olkin (KMO) measure, Bartlett’s test, and principal component analysis with varimax rotation. Screening performance (concordance) was analyzed by ROC curves (AUC), sensitivity/specificity, Youden’s J, and likelihood ratios (LR+/LR−), using FLACC>3 as a behavioral reference measure rather than a delirium-specific reference standard. Results: Mean age was 73.4±29.8 months; 97.3% were male. Internal consistency for PAED-T was α=0.728–0.741. A two-component solution outperformed a one-component model: ED-I (eye contact, purposeful actions, awareness of surroundings; loadings 0.708–0.877; ω=0.750) and ED-II (restlessness, inconsolability; loadings 0.898–0.909; ω=0.833). PAED-T showed a moderate positive correlation with FLACC (ρ=0.373) and a weak negative correlation with MAS (ρ=−0.163). ROC analysis yielded an AUC of 0.794; at a cutoff ≥10, sensitivity was 87.5%, specificity 59.4%, and LR− 0.21. Conclusion: PAED-T is a valid and reliable tool for screening and monitoring behaviors consistent with emergence delirium in pediatric anesthesia. A cutoff ≥10 is pragmatic for screening; however, ROC findings should be interpreted as screening concordance, given that FLACC is not delirium-specific.

Keywords

• delirium
• general anesthesia
• emergence delirium
• pediatric anesthesia
• validity
• ROC curve

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