Virtual reality may decrease procedural distress in pediatric IV placement - 2 Minute Medicine

1. In a single-center randomized power trial, young children successful the pediatric exigency country who participated successful a virtual world (VR) acquisition had little standardized symptom scores during the placement of intravenous catheters (IVs).

2. Subgroup investigation suggested that the effect of the VR acquisition connected decreasing disposable distress and perceived symptom was stronger for pistillate patients.

Evidence Rating Level: 2 (Good)

Study Rundown: Inflicting procedural discomfort connected children represents a important situation for providers and caregivers successful pediatric practice. Researchers astatine Seoul National University built upon the expanding assemblage of grounds for the usage of virtual world arsenic an effectual means of symptom simplification by creating a high-resolution VR simulation that placed pediatric patients successful the mediate of a wood exploration with 4 carnal friends, projecting this simulation connected a domed ceiling successful a procedural attraction room. Eighty-eight children aged 6 months to 4 years undergoing IV placement were randomized to either modular distraction techniques oregon distraction with the VR experience. The children’s responses to IV placement were video-recorded, with symptom strength assessments assigned by 2 protocol-blinded physicians utilizing the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Caregivers were provided a questionnaire querying their restitution with the process and their appraisal of their child’s pain. Overall, the VR involution resulted successful a importantly decreased probability of having higher FLACC scores. Moreover, caregivers rated their child’s symptom and anxiousness importantly little if they were assigned to the VR experimental group, though determination was nary quality successful their restitution with the wide procedure. While this lends enactment to the increasing involvement successful virtual world arsenic a method of intelligence symptom mitigation, the survey suffers from method and plan limitations. Despite the wide simplification successful FLACC scores passim the entirety of the process successful the VR group, distress astatine captious points successful the process (i.e. tourniquet placement, needle insertion) was not importantly antithetic betwixt the power and experimental groups. Interestingly, subgroup investigation stratified by enactment showed a important alteration successful FLACC scores for girls randomized to the VR experience, but not for boys successful the aforesaid experimental group, with the authors positing that societal expectations and/or the contented of the VR acquisition whitethorn lend to this gender-specific difference.

Click to work the survey successful JAMA Pediatrics

Relevant Reading: The effectiveness of virtual world distraction for symptom reduction:  a systematic review.  

In-Depth [randomized controlled trial]: This single-center parallel, two-group randomized controlled proceedings identified eighty-eight children ages 4 months to 6 years requiring non-urgent IV placement successful the pediatric exigency room. Subjects were randomized into 2 groups: the power radical received modular IV placement procedures portion the 2nd radical participated successful a caller virtual world acquisition consisting of an imagined wood exploration with 4 affable animals. Primary result measures were FLACC standardized symptom assessments astatine 5 clip points (T0=baseline, T1=immediately aft kid laid connected the bed, T2=tourniquet application, T3=alcohol swabbing, T4=venipuncture) that were rated by 2 independent, protocol-blinded physicians reviewing a video signaling of the procedure. Secondary outcomes included parent/caregiver restitution with the process and their subjective ratings of their children’s symptom and anxiousness connected a 0-10 ocular analog scale. Children assigned to the VR acquisition had importantly decreased likelihood of having higher FLACC scores compared to children successful the power radical (IQR 1.1-5.4 vs IQR 1.8-6.9, OR 0.53, p=0.049), though determination was nary important quality erstwhile idiosyncratic clip points were compared crossed groups. Repeated measurement investigation of variance for subgroups revealed that this effect persisted erstwhile assessing lone girls crossed some experimental radical and procedural clip constituent (F=6.56, P=0.1 and F = 14.31, P<0.001 respectively), but failed to look erstwhile lone boys were included successful the analysis. Caretakers reported importantly little perceptions of their child’s symptom (5.0 [3.0-8.0] vs 7.0 [5.0-10.0], P=0.08) and anxiousness (5.0 [3.0-7.0] vs 8.0 [6.5-10.0], P<0.001)  if they were successful the experimental VR group, though nary important differences successful wide restitution with the procedure.

Image: PD

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