The Türkiye version of the pediatric anesthesia emergence delirium (PAED) scale: translation and cross-cultural adaptation

Abstract

Aim Emergence delirium (ED) is a frequent and challenging complication in children after general anesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is widely used for its assessment, yet cultural adaptation is necessary. This study aimed to translate, adapt, and evaluate the Türkiye version of the PAED scale. Methods A methodological study was conducted at Selçuk University between March and May 2025, including 373 pediatric patients aged 2–16 years (American Society of Anesthesiologists [ASA] I–III) undergoing elective surgery under general anesthesia. Exclusion criteria were neurological, psychiatric, or developmental disorders, emergency surgery, or major complications. The PAED scale was adapted according to Beaton’s six-step framework and WHO/consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. Two independent raters (an anesthesiologist and a post-anesthesia care unit [PACU] nurse) assessed each patient at recovery (T0) and 10 minutes later (T1). Internal consistency was measured with Cronbach’s α, inter-rater reliability with the intraclass correlation coefficient (ICC), and the concordance correlation coefficient (CCC). Deming regression and Bland–Altman analyses were used to evaluate bias and agreement. Results The mean age was 7.46 ± 3.89 years; 68% were male. Median surgery and anesthesia times were 30 and 40 minutes, respectively. Cronbach’s α at T0 was 0.857 (Rater 1) and 0.817 (Rater 2), slightly decreasing at T1 (0.745 and 0.688). Inter-rater reliability remained excellent (ICC > 0.90; CCC > 0.90). Regression and Bland–Altman analyses confirmed minimal bias and strong agreement. Conclusion The Türkiye PAED scale showed reliability and validity, with excellent inter-rater agreement and acceptable measurement error. It provides a tool for assessing ED in Türkiye populations.