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Virtual reality for intravenous placement in the emergency department—a randomized controlled trial

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Abstract

This study sought to determine whether adding virtual reality (VR) was superior to standard of care alone in facilitating reduction in pain and anxiety among children who underwent intravenous catheterization in the emergency department (ED). Sixty-six children aged 6–16 years who needed intravenous placement received VR, or standard of care in the ED (videos, television, iPad, child life specialist). Outcome measures included change in pain score, level of anxiety, patient and parent satisfaction (pain and anxiety), number of trials, and procedure time. Compared with controls, the intervention group had similar age, sex, number of trials, and anesthetic use. Time of procedure was shorter in the VR group (median 5 min) but this was not statistically significant compared with 7 min for the control group. Pain in the intervention group was lower, even before the procedure. Difference in pain (before and after) and anxiety (after the procedure) were similar in both groups. Satisfaction from anxiety management was higher for the VR group (p < 0.007) and children rated VR significantly more “fun” (p < 0.024).

Conclusion: VR was an effective distraction tool and increased satisfaction from anxiety management for this common pediatric procedure, and should be incorporated in management of anxiety in children in the ED setting.

Trial registration: clinicaltrials.gov ID NCT03681730, https://clinicaltrials.gov/ct2/show/NCT03681730

What is Known:

• Virtual reality is an evolving computer technology that shows some promise in the areas of acute and chronic pain management due to its ability to create effective distraction.

What is New:

• We report that among children in the emergency setting with intravenous catheterization, satisfaction from the use of VR for anxiety management should support implementation of VR systems for this procedure

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Abbreviations

CAS:

Colored Analogue Scale

ED:

Emergency department

EMLA:

Eutectic Mixture of Local Anesthetics

FPS-R:

Faces Pain Scale – Revised

IRB:

Institutional Review Board

IQR:

Interquartile range

IV:

Intravenous catheter

VR:

Virtual reality

VAS:

Visual Analogue Scale

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Acknowledgements

We are grateful for the patients that participated in this study. A special acknowledgement to Paul Clerc, Charlotte Zwimpfer, Jennifer Ham, Clare Lambert, Isabelle Khalifa, and Nancy Lum who collected data for this study.

Contributors’ contributions

Dr. Goldman and Dr. Behboudi conceptualized and designed the study, submitted to ethics approval, and monitored collection of data. Dr. Goldman and Dr. Behboudi drafted the initial manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding

Funded by the Peace Arch Hospital, as part of an improvement project. Funds were allocated for a research assistant and all other administrative measures related to presentation and publication of the trial results.

Author information

Authors and Affiliations

  1. The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada

    Ran D. Goldman

  2. BC Children’s Hospital Research Institute, Vancouver, BC, Canada

    Ran D. Goldman

  3. Emergency Medicine, Peace Arch Hospital, White Rock, BC, Canada

    Amir Behboudi

Authors
  1. Ran D. Goldman
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  2. Amir Behboudi
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Correspondence to Ran D. Goldman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (University of British Columbia Clinical Research Ethics Board, H17-02711) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Disclaimer

The funding agency had no influence on the design of the study, its conduct or publication of data from this project.

Additional information

Communicated by Gregorio Paolo Milani

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Goldman, R.D., Behboudi, A. Virtual reality for intravenous placement in the emergency department—a randomized controlled trial. Eur J Pediatr 180, 725–731 (2021). https://doi.org/10.1007/s00431-020-03771-9

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  • DOI: https://doi.org/10.1007/s00431-020-03771-9

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