Abstract
Background
Although procedural pain is effectively treated with analgesics, managing anxiety
during laceration repair is more challenging.
Objectives
We examined the feasibility of using immersive virtual reality (VR) as anxiolysis
during laceration repair in the pediatric emergency department (ED).
Methods
We conducted a non-blinded, observational, pilot study in an urban pediatric ED that
enrolled a convenience sample of children aged 5–13 years undergoing sutured repair
of non-facial lacerations. Subjects played an immersive VR game while undergoing laceration
repair. Parents assessed their child's anxiety on a 100-mm visual analogue scale at
enrollment and during laceration repair. The primary outcome measure was the percentage
of children whose anxiety score did not increase by ≥ 20 mm from enrollment to the
first stitch.
Results
Forty patients completed the study. Mean initial anxiety score was 54 mm (standard
deviation 33 mm). Thirty-seven of forty patients (93%; 95% confidence interval [CI]
83–99%) had anxiety scores that did not increase by 20 mm or more from enrollment
to the first stitch. Eighty percent (95% CI 64–91%) of patients’ anxiety scores decreased
between enrollment and first stitch. The mean change in anxiety score at first stitch
was −39 mm (95% CI −51 mm to −27 mm; p < 0.001). Similar downward trends in anxiety scores were noted throughout the procedure.
All laceration repairs were successfully completed without sedation or restraints.
There were no adverse events noted, and the main barriers identified with VR use involved
easily correctable technical difficulties with the equipment.
Conclusion
Immersive VR is a safe and effective distractive technique to reduce procedural anxiety
during laceration repair in the pediatric ED.
Keywords
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Article info
Publication history
Published online: August 04, 2022
Accepted:
January 25,
2022
Received in revised form:
January 14,
2022
Received:
November 4,
2021
Footnotes
Prior Presentations: This study was presented under the title “Virtual Reality as Anxiolysis for Children Undergoing Laceration Repair in the Pediatric Emergency Room: A Pilot Study,” as a platform presentation at the Eastern Society for Pediatric Research (ESPR) meeting in Philadelphia, PA on March 24, 2019 and as a poster at the Pediatric Academic Society (PAS) Meeting in Baltimore, MD on April 30, 2019. This work was also presented internally at Montefiore Medical Center in the Bronx, NY, where it won 3rd prize for an oral presentation at the Einstein Young Investigator Research Symposium on March 4, 2019 and an award for Outstanding Poster at Montefiore's Pediatric Research Day on April 10, 2019.
Clinical Trial Registration: This study was registered at www.clinicaltrials.gov with NCT number NCT03475901. (https://www.clinicaltrials.gov/ct2/show/NCT03475901?term=NCT03475901&draw=2&rank=1)
Identification
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