Development of the Pediatric Scale for Quality of Recovery (PedSQoR)

Background: Measuring the quality of a patient's recovery is vital, and reliable patient-centered outcome metrics are needed for clinical investigations and quality improvement. Currently, assessment tools to measure quality of recovery in pediatric patients are lacking. This study aimed to develop a scale to assess the quality of recovery (QoR) construct in pediatric patients. Methods: Using a mixed-methods investigative model, item generation was achieved using two complementary approaches. First, a comprehensive review of the literature identified tools and questions that assessed the endpoints relevant to recovery in children. Questions were categorized and then assessed by an expert Delphi panel who determined the most significant domains and items to be included. Concurrently, semi-structured interviews were conducted with patients and their families to identify themes related to recovery that were important to patients and families. The resulting pilot questionnaire was administered to patients and their families presenting for elective surgery in the US and Australia. Results: The literature search identified 41 instruments, comprising 216 questions relevant to recovery. After the initial Delphi round, the item list was reduced to 91 questions, and then to 50 questions after the second round. The themes identified in the semi-structured interviews aligned with domains considered important by a panel of experts. A 50-item questionnaire was administered to 1162 children, at multiple time points post-surgery. Item reduction and factor analysis resulted in the 20-item Pediatric Scale for Quality of Recovery (PedSQoR) that assesses the domains relevant to physical and psychological recovery. Conclusions: The PedSQoR scale is a 20-item questionnaire designed to provide a holistic representation of a child’s physical, emotional, and psychological recovery after surgery and anesthesia. It was developed and validated with consumer involvement and a strong patient-centered focus. Once further validation has been established, it is expected to become a standardized endpoint in pediatric perioperative trials and quality improvement projects.