Effect of Daily Screen Time on Postoperative Emergence Delirium in Children Aged 2-11 Years

The Effect of Daily Screen Exposure Duration on Postoperative Emergence Delirium in Children Undergoing Elective Lower Abdominal Surgery: A Prospective Observational Study

This prospective observational study aims to evaluate the association between daily screen exposure duration and postoperative emergence delirium in children aged 2 to 11 years undergoing elective lower abdominal surgery. Daily screen time will be assessed using a parent-reported questionnaire administered preoperatively. Postoperative emergence delirium will be evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale at 5, 10, 15, and 30 minutes after surgery.

The primary outcome is the association between daily screen time and PAED score within the first 30 minutes postoperatively. Secondary outcomes include the associations between PAED score and age at first screen exposure, type of viewed content, parental screen use, passive screen exposure, and the presence of a screen in the child's bedroom. The study is designed to improve understanding of whether screen-related environmental factors are associated with postoperative behavioral recovery in pediatric surgical patients.

Study Overview

• Status: Not yet recruiting
• Conditions: Agitation; Postoperative Agitation
• Intervention / Treatment: Diagnostic test: Daily Screen Exposure Duration

Detailed Description

Postoperative emergence delirium is a common behavioral disturbance in children after general anesthesia and may be associated with delayed recovery, increased distress, and greater need for postoperative management. Environmental and behavioral factors that may influence postoperative agitation are not yet fully understood. Screen exposure has become a major part of early childhood life, and excessive or early exposure has been associated with emotional dysregulation, anxiety-related symptoms, and behavioral difficulties. However, the relationship between daily screen time and postoperative emergence delirium has not been adequately studied.

This study is a prospective, single-center, observational cohort study conducted in children aged 2 to 11 years undergoing elective lower abdominal surgery, including inguinal hernia repair, orchiopexy for undescended testis, and circumcision. After written informed consent is obtained from the parent or legal guardian, a structured questionnaire will be completed in the preoperative waiting area. The questionnaire will collect information on daily screen exposure duration, age at first screen exposure, type of content viewed, parental screen use, passive screen exposure in the home environment, and the presence of a screen in the child's bedroom. Sociodemographic and clinical variables, including age, sex, parental education status, previous surgery or anesthesia history, ASA physical status, and type of surgery, will also be recorded.

No active intervention will be applied. This is a non-interventional observational study in which daily screen exposure duration is the exposure of interest. Participants may be categorized into screen exposure groups for descriptive and comparative analyses, but the primary analysis will evaluate the association between daily screen time as a continuous variable and PAED score.

Postoperative emergence delirium will be assessed using the Pediatric Anesthesia Emergence Delirium scale. PAED scoring will be performed by the study investigator at 5, 10, 15, and 30 minutes postoperatively, after the child has recovered sufficiently for assessment. Higher PAED scores indicate more severe emergence delirium symptoms.

The primary outcome measure is the association between daily screen time and PAED score within the first 30 minutes postoperatively. Secondary outcome measures include the associations between PAED score and age at first screen exposure, type of screen content, parental screen use, passive screen exposure, and the presence of a screen in the bedroom. Additional exploratory analyses may examine the influence of demographic and clinical variables on PAED scores.

Children will be excluded if they receive premedication, undergo emergency surgery or reoperation, have developmental delay, neurodevelopmental or psychiatric disorders, visual or hearing impairment interfering with behavioral assessment, current use of sedative, antipsychotic, or antiepileptic medications, anticipated postoperative intensive care requirement, or incomplete parent-reported questionnaire data.

The findings of this study may help identify screen-related factors associated with postoperative emergence delirium and may contribute to improved preoperative risk assessment and family guidance in pediatric surgical practice.

• Study Type: Observational
• Enrollment (Estimated): 288

Contacts and Locations

• Study Contact: Name: Engin ihsan Turan, principal investigator; Phone Number: +905382431114; Email: enginihsan@hotmail.com

Study Locations

• Turkey (Türkiye)
  • Istanbul
    • Istanbul, Istanbul, Turkey (Türkiye), 34303
      • Health Science University İstanbul Kanuni Sultan Süleyman Education and Training Hospital
      • Contact: Engin ihsan Turan; Phone Number: 05382431114; Email: enginihsan@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

The study population consists of children aged 2-11 years undergoing elective lower abdominal surgery, including inguinal hernia repair, orchiopexy for undescended testis, and circumcision, at a tertiary care hospital. Participants are classified according to daily screen exposure duration based on parent-reported data. Only patients meeting the inclusion criteria and whose parents provide written informed consent will be enrolled. Children with developmental, neurological, or psychiatric disorders, or those receiving premedication, will be excluded to ensure reliable behavioral assessment using the PAED scale.

Description

Inclusion Criteria:

• Children aged 2 to 11 years
• Scheduled for elective lower abdominal surgery
• Planned procedures include inguinal hernia repair, orchiopexy for undescended testis, or circumcision
• American Society of Anesthesiologists (ASA) physical status I-II
• Parent or legal guardian able to provide written informed consent
• Parent or legal guardian able to complete the study questionnaire

Exclusion Criteria:

• Planned or administered premedication before surgery
• Emergency surgery
• Reoperation
• Developmental delay, neurodevelopmental disorder, or known psychiatric disease
• Visual or hearing impairment that may interfere with behavioral assessment
• Current use of sedative, antipsychotic, or antiepileptic medication
• Anticipated postoperative intensive care unit requirement
• Incomplete or unreliable parent-reported questionnaire data

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Low Screen Exposure (<2 Hours/Day); Children aged 2-11 years undergoing elective lower abdominal surgery with daily screen exposure of less than 2 hours, as reported by parents. Postoperative emergence delirium will be assessed using the PAED score.	Diagnostic test: Daily Screen Exposure Duration; This is a non-interventional observational study. The exposure of interest is the daily screen time duration of children aged 2-11 years, as reported by parents. Participants are categorized into two groups based on screen exposure (<2 hours/day and >2 hours/day). No active intervention is applied.
High Screen Exposure (>2 Hours/Day); Children aged 2-11 years undergoing elective lower abdominal surgery with daily screen exposure of more than 2 hours, as reported by parents. Postoperative emergence delirium will be assessed using the PAED score.	Diagnostic test: Daily Screen Exposure Duration; This is a non-interventional observational study. The exposure of interest is the daily screen time duration of children aged 2-11 years, as reported by parents. Participants are categorized into two groups based on screen exposure (<2 hours/day and >2 hours/day). No active intervention is applied.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Association Between Daily Screen Time and PAED Score	Correlation between daily screen exposure duration (continuous variable) and PAED score.	Within the first 30 minutes after emergence from anesthesia

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age at First Screen Exposure and Emergence Delirium	Association between age at first screen exposure and PAED score.	Within the first 30 minutes postoperatively
Influence of Sociodemographic Factors on Emergence Delirium	Assessment of the effect of age, sex, parental education level, and family structure on PAED scores.	Within the first 30 minutes postoperatively
Type of Screen Content and Emergence Delirium	Evaluation of the relationship between type of content viewed (cartoons, games, educational, mixed) and PAED score.	Within the first 30 minutes postoperatively
Parental Screen Use and Emergence Delirium	Association between parental daily screen use and PAED score.	Within the first 30 minutes postoperatively
Passive Screen Exposure and Emergence Delirium	Evaluation of the effect of background screen exposure in the home environment on PAED score.	Within the first 30 minutes postoperatively

Collaborators and Investigators

• Sponsor: Kanuni Sultan Suleyman Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): May 2, 2027

Study Registration Dates

• First Submitted: April 20, 2026
• First Submitted That Met QC Criteria: April 20, 2026
• First Posted (Actual): April 27, 2026

Study Record Updates

• Last Update Posted (Actual): April 27, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Aberrant Motor Behavior in Dementia; Neurologic Manifestations; Nervous System Diseases; Behavioral Symptoms; Neurobehavioral Manifestations; Dyskinesias; Psychomotor Disorders; Pathological Conditions, Signs and Symptoms; Behavior; Signs and Symptoms; Psychomotor Agitation
• Other Study ID Numbers: screen time and agitation

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No