Virtual Reality May Reduce Procedural Distress During Pediatric IV Placement |  Medicine in 2 Minutes

Virtual Reality May Reduce Procedural Distress During Pediatric IV Placement | Medicine in 2 Minutes

1. In a single-center randomized controlled trial, young children in the pediatric emergency room who participated in a virtual reality (VR) experience had lower standardized pain scores during the placement of intravenous (IV) catheters ).

2. Subgroup analysis suggested that the effect of virtual reality experience on decreasing visible distress and perceived pain was stronger in female patients.

Level of evidence assessment: 2 (good)

Summary of the study: Inflicting procedural discomfort on children represents a significant challenge for providers and caregivers in pediatric practice. Researchers at Seoul National University built on the growing body of evidence for the use of virtual reality as an effective means of pain reduction by creating a high-resolution VR simulation that placed pediatric patients in the middle of a forest exploration with four animal friends, projecting this simulation onto a vaulted ceiling in a procedural processing room. Eighty-eight children aged 6 months to 4 years undergoing intravenous placement were randomized to receive either standard distraction techniques or distraction with virtual reality experience. The children’s responses to IV placement were videotaped, with ratings of pain intensity assigned by two protocol-blind physicians using the FLACC (Face, Legs, Activity, Cry, and Consolability) scale. Caregivers received a questionnaire asking about their satisfaction with the procedure and their assessment of their child’s pain. Overall, the VR intervention resulted in a significant decrease in the likelihood of having higher FLACC scores. Additionally, caregivers rated their child’s pain and anxiety significantly lower if assigned to the VR experimental group, although there was no difference in their satisfaction with the VR treatment. overall procedure. While this supports the growing interest in virtual reality as a psychological pain alleviation method, the study suffers from technical and design limitations. Despite the overall reduction in FLACC scores throughout the procedure in the VR group, distress at critical procedural points (i.e., tourniquet placement, needle insertion) was not not significantly different between the control group and the experimental group. Interestingly, subgroup analysis stratified by sex showed a significant decrease in FLACC scores for girls randomized to the VR experience, but not for boys in the same experimental group, with the authors postulating that social expectations and /or the content of the VR experience may contribute to this gender-specific difference.

Click to read the study in JAMA Pediatrics

Relevant reading: The effectiveness of virtual reality distraction for pain reduction: a systematic review.

In depth [randomized controlled trial]: This parallel, single-center, two-group randomized controlled trial identified eighty-eight children aged 4 months to 6 years in need of elective intravenous placement in the pediatric emergency room. Subjects were randomized into two groups: the control group received standard IV placement procedures while the second group participated in a new virtual reality experience consisting of an imaginary forest exploration with four friendly animals. The primary outcomes were FLACC standardized pain ratings at five time points (T0 = baseline, T1 = immediately after the child was laid on the bed, T2 = tourniquet application, T3 = swab at the alcohol, T4 = venipuncture) which were evaluated by two independent protocols. blind doctors reviewing a video recording of the procedure. Secondary outcomes included parent/caregiver satisfaction with the procedure and their subjective ratings of their children’s pain and anxiety on a visual analogue scale from 0 to 10. Children assigned to the virtual reality experience had a significantly reduced likelihood of having higher FLACC scores compared to children in the control group (IQR 1.1-5.4 vs IQR 1.8-6.9, OR 0.53, p = 0.049), although there was no significant difference when individual time points were compared between groups. Repeated measures analysis of variance for subgroups revealed that this effect persisted when assessing girls only in the experimental group and time point of the procedure (F = 6.56, P = 0, 1 and F = 14.31, P < 0.001 respectively), but did not emerge when only boys were included in the analysis. Caregivers reported significantly lower perceptions of their child's pain (5.0 [3.0-8.0] vs. 7.0 [5.0-10.0]P=0.08) and anxiety (5.0 [3.0-7.0] against 8.0 [6.5-10.0]P<0.001) if they were in the VR experimental group, although there were no significant differences in overall satisfaction with the procedure.

Picture: PD

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