The Relationship Between Socioeconomic Status and Emergence Delirium: A Retrospective Cohort Study

BACKGROUND: Emergence delirium (ED) is a common phenomenon in pediatric populations and is characterized by altered consciousness, manifesting as either agitation or a hypoactive state. While the link between socioeconomic status and chronic stress has been well studied and linked to poor health outcomes, no research to date has explored the impact that socioeconomic status has on ED in pediatric populations. AIMS: This study investigated how socioeconomic status impacts ED in pediatric patients undergoing common outpatient procedures. METHODS: We conducted an analysis of pediatric patients at one tertiary care center who received one of three common, stimulating, outpatient procedures: venting myringotomy, intestinal endoscopy, or dermatologic laser surgery. The Modified Yale Pediatric Anxiety Scale (mYPAS) and Pediatric Anesthesia Emergence Delirium (PAED) screening tools were administered, and demographic factors were collected for each patient. Socioeconomic status was determined using each patient's address and the Area Deprivation Index (ADI), a validated metric created by the University of Wisconsin. Statistical analysis was performed using logistic regression with an outcome of emergence delirium and with ADI as a three-category categorical variable. RESULTS: Patients in the highest ADI group had a significantly higher probability of experiencing emergence delirium compared to patients in the lowest ADI group, adjusting for age and postoperative pain score. CONCLUSIONS: This data suggests that children from low socioeconomic backgrounds are more likely to experience emergence delirium. This is the first study tying socioeconomic status to emergence delirium, or any anesthesia complication, in pediatric patients. Future studies should investigate strategies to mitigate emergence delirium and explore associations between socioeconomic status and other anesthesia complications.