Background Emergence Delirium (ED) is a common complication from anesthesia. Although ED has a short duration, detection is important due to the risk that ED poses for post‐operative complications in the child. The Pediatric Anesthesia Emergence Delirium (PAED) scale has been translated into Danish, but it has not yet been validated. The aim of this study was to investigate the inter‐rater reliability, criterion validity, and responsiveness of the Danish version of the PAED scale as well as to determine the prevalence of ED. Method A sample of 100 post‐operative children were enrolled and assessed with the PAED scale at pre‐specified time intervals. Inter‐rater reliability was assessed independently by 2 raters. For criterion validity, a clinical expert was chosen as the gold standard. Sensitivity and specificity were based on a comparison between the scoring of the raters and the gold standard. Responsiveness was assessed by comparing changes in scores. Prevalence was based on the PAED scale's cut‐off level of ≥10 points. Results A high level of agreement was found, with an intraclass correlation coefficient of 0.85‐0.94. Few outliers appeared in the Bland‐Altman plot. Sensitivity ranged from 70% to 86%, and the specificity of both raters against the gold standard was 100%. Changes in scores were indicative of responsiveness. Prevalence was 13.2%. Conclusion The Danish version of the PAED scale was found reliable and demonstrated high levels of sensitivity and specificity. In addition, it was possible to identify changes in scores over time. Prevalence was in line with existing literature.

Background Delirium is a serious medical problem and recognized as a common syndrome in critically ill children. Without routine screening, delirium diagnosis is often missed by the medical providers. Internationally, there are tools to assess pediatric delirium (PD), but none currently available in Danish. The aim of this project was to translate the Cornell Assessment of Pediatric Delirium (CAPD) into Danish and determine its feasibility and reliability in a Danish clinical setting. Methods Translation was done in accordance with WHO guidelines. Linguistic and cultural differences were reconciled with the original developers of the instrument. The Danish CAPD was then tested in a prospective cohort of children admitted to a single pediatric intensive care unit at a university hospital in Denmark. Inter‐rater reliability was determined using weighted Kappa statistics. Results Thirty children were enrolled, and 92 delirium assessments were completed. Inter‐rater reliability (n = 84) revealed that inter‐observer agreement among the nurses was high (κ 0.85). The Danish version of the CAPD was successfully administered in all children. Conclusions Standardized assessment tools are a pre‐requisite to identify PD. A Danish version of the CAPD now exists, and preliminary testing has demonstrated it as feasible and reliable for use in a Danish clinical setting. A multi‐institutional study is needed to determine the prevalence of PD in Denmark.

Background: Fluid administration and resuscitation of patients with sepsis admitted through emergency departments (ED) remains a challenge, and evidence is sparse especially in sepsis patients without shock. We aimed to investigate emergency medicine physicians' and nurses' perceptions, self-reported decision-making and daily behavior, and challenges in fluid administration of ED sepsis patients. Methods: We developed and conducted a multicenter, web-based, cross-sectional survey focusing on fluid administration to ED patients with sepsis sent to all nurses and physicians from the five EDs in the Central Denmark Region. The survey consisted of three sections: (1) baseline information; (2) perceptions of fluid administration and daily practice; and (3) clinical scenarios about fluid administration. The survey was performed from February to June, 2021. Results: In total, 138 of 246 physicians (56%) and 382 of 595 nurses (64%) responded to the survey. Of total, 94% of physicians and 97% of nurses regarded fluid as an important part of sepsis treatment. Of total, 80% of physicians and 61% of nurses faced challenges regarding fluid administration in the ED, and decisions were usually based on clinical judgment. The most common challenge was the lack of guidelines for fluid administration. Of total, 96% agreed that they would like to learn more about fluid administration, and 53% requested research in fluid administration of patients with sepsis. For a normotensive patient with sepsis, 46% of physicians and 44% of nurses administered 1000 ml fluid in the first hour. Of total, 95% of physicians and 89% of nurses preferred to administer ≥1000 ml within an hour if the patients' blood pressure was 95/60 at admission. There was marked variability in responses. Blood pressure was the most commonly used trigger for fluid administration. Respondents preferred to administer less fluid if the patient in the scenario had known renal impairment or heart failure. Normal saline was the preferred fluid. Conclusion: Fluid administration is regarded as an important but challenging aspect of sepsis management. Responses to scenarios revealed variability in fluid volumes. Blood pressure was the most used trigger. ED nurses and physicians request evidence-based guidelines to improve fluid administration.