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Utsumi S, Maiko S, Moriwaki T, Miyake H, Yuhei S, Kubota S, Uematsu S, Takehara K, Kubota M. Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure. Hosp Pediatr 2024; 14:e123-e131. [PMID: 38273770 DOI: 10.1542/hpeds.2023-007322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CONTEXT Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers. OBJECTIVES We aimed to assess the benefits of NPD to medical providers. DATA SOURCES We searched 5 databases for relevant articles. STUDY SELECTION Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included. DATA EXTRACTION Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy. RESULTS We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff. CONCLUSIONS Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.
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Affiliation(s)
- Shu Utsumi
- Division of Emergency and Transport Services
| | | | | | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Shimada Yuhei
- School of Public Health, Department of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shoko Kubota
- School of Public Health, Department of Medicine, the University of Tokyo, Tokyo, Japan
| | | | | | - Mitsuru Kubota
- General Medicine and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
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Goren K, Cen Y, Montemurri V, Moodley D, Sutton A, Ahmed A, Alphonsus L, Denezis P, Fleming C, Guertin H, Hyland K, Kalim A, Kim HH, Krause S, Liang A, Maclean E, Neocleous P, Patel A, Pritchard S, Purcell V, Qaqish M, Ryall S, Shum K, Suwary K, Vucetic A, Skinner J, Woolsey A, Marcotte E. The impact of music, play, and pet therapies in managing pain and anxiety in paediatric patients in hospital: a rapid systematic review. Paediatr Child Health 2023; 28:218-224. [PMID: 37287483 PMCID: PMC10243982 DOI: 10.1093/pch/pxad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/29/2023] [Indexed: 06/09/2023] Open
Abstract
Background Hospitalized children face pain and anxiety associated with the environment and procedures. Objective This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible. Methods Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies. Results A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety. Conclusion Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.
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Affiliation(s)
- Katherine Goren
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Yuchen Cen
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Vanessa Montemurri
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Dirusha Moodley
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Arielle Sutton
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Alveena Ahmed
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Lotus Alphonsus
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Peter Denezis
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Courtney Fleming
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Hailey Guertin
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Kiley Hyland
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Ayesha Kalim
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Harry Hyunteh Kim
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Sarah Krause
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Aileen Liang
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Eleanor Maclean
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Penelope Neocleous
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Arjun Patel
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Sharon Pritchard
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Victoria Purcell
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Michael Qaqish
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Stephanie Ryall
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Kathryn Shum
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Kylie Suwary
- Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
| | - Andrea Vucetic
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Jamila Skinner
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Amadene Woolsey
- Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Emily Marcotte
- Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Windsor, Windsor, Ontario
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Poonai N, Sabhaney V, Ali S, Stevens H, Bhatt M, Trottier ED, Brahmbhatt S, Coriolano K, Chapman A, Evans N, Mace C, Creene C, Meulendyks S, Heath A. Optimal Dose of Intranasal Dexmedetomidine for Laceration Repair in Children: A Phase II Dose-Ranging Study. Ann Emerg Med 2023:S0196-0644(23)00037-9. [PMID: 36870890 DOI: 10.1016/j.annemergmed.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 03/06/2023]
Abstract
STUDY OBJECTIVE To determine the optimal sedative dose of intranasal dexmedetomidine for children undergoing laceration repair. METHODS This dose-ranging study employing the Bayesian Continual Reassessment Method enrolled children aged 0 to 10 years with a single laceration (<5 cm), requiring single-layer closure, who received topical anesthetic. Children were administered 1, 2, 3, or 4 mcg/kg intranasal dexmedetomidine. The primary outcome was the proportion with adequate sedation (Pediatric Sedation State Scale score of 2 or 3 for ≥90% of the time from sterile preparation to tying of the last suture). Secondary outcomes included the Observational Scale of Behavior Distress-Revised (range: 0 [no distress] to 23.5 [maximal distress]), postprocedure length of stay, and adverse events. RESULTS We enrolled 55 children (35/55 [64%] males; median [interquartile range {IQR}] age 4 [2, 6] years). At 1, 2, 3, and 4 mcg/kg intranasal dexmedetomidine, respectively, the proportion of participants "adequately" sedated was 1/3 (33%), 2/9 (22%), 13/21 (62%), and 12/21 (57%); the posterior mean (95% equitailed credible intervals) for the probability of adequate sedation was 0.38 (0.04, 0.82), 0.25 (0.05, 0.54), 0.61 (0.41, 0.80), and 0.57 (0.36, 0.76); the median (IQR) Observational Scale of Behavior Distress-Revised scores during suturing was 2.7 (0.3, 3), 0 (0, 3.8), 0.6 (0, 5), and 0 (0, 3.7); the median (IQR) postprocedure length of stay was 67 (60, 78), 76 (60, 100), 89 (76, 109), and 113 (76, 150) minutes. There was 1 adverse event, a decrease in oxygen saturation at 4 mcg/kg, which resolved with head repositioning. CONCLUSION Despite limitations, such as our limited sample size and subjectivity in Pediatric Sedation State Scale scoring, sedation efficacy for 3 and 4 mcg/kg were similarly based on equitailed credible intervals suggesting either could be considered optimal.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Vikram Sabhaney
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Women and Children's Research Institute, Edmonton, Alberta, Canada
| | - Holly Stevens
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Department of Pediatrics, CHU Ste Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Shaily Brahmbhatt
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kamary Coriolano
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Amanda Chapman
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Natalie Evans
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Charlotte Mace
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Creene
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sarah Meulendyks
- Department of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Lee HN, Hwang S, Jung JY, Park JW, Kim DK, Kwak YH. Tablet personal computer distraction during intravenous placement for young children in the pediatric emergency department: A pilot study. Pediatr Int 2022; 64:e15150. [PMID: 35510723 DOI: 10.1111/ped.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous (IV) placement is a common procedure experienced by children visiting the pediatric emergency department (PED). However, uncontrolled anxiety and pain cause children to interfere with the procedure. In this pilot study, we sought to evaluate the effectiveness of tablet personal computers as a distraction method during IV placement. METHODS This is a single-center pilot study conducted at a tertiary teaching hospital. Children visiting the PED were eligible if they were aged 3-5 years and required IV placement during the PED visit. After written consent was obtained from the guardian, the child was randomly assigned to a control group or an intervention group. For the intervention group, an animated video was played via tablet PC during IV placement. For both groups, children's anxiety, heart rate, and pain scale scores (the Face, Legs, Activity, Cry, Consolability and Evaluation Enfant Douleur) and guardian satisfaction were recorded. RESULTS 22 children were eligible for the final analysis. There was no significant difference in the pain scale scores between the two groups, with the exception of the degree of pain relief after the procedure measured using Evaluation Enfant Douleur (intervention group: 6.0, interquartile range (IQR): 4.2-6.8, and control group; 3.0, IQR: 2.0-3.8, P = 0.011) and Face, Legs, Activity, Cry, Consolability (intervention group: 4.0, IQR: 4.0-4.2 and control group; 3.0, IQR: 1.5-3.5, P = 0.043). CONCLUSION In this pilot study, distraction using tablet personal computers may have reduced children's distress during the recovery phase after venipuncture. Further study with a larger sample size and different methods of distraction is essential.
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Affiliation(s)
- Ha Ni Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Jae Yun Jung
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Joong Wan Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Do Kyun Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Young Ho Kwak
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
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