Distraction in the Emergency department using Virtual reality for INtravenous procedures in Children to Improve comfort (DEVINCI): a pilot pragmatic randomized controlled trial.

OBJECTIVES: Intravenous (IV) procedures cause pain and distress in the pediatric emergency department (ED). We studied the feasibility and acceptability of virtual reality distraction for patient comfort during intravenous procedures. METHODS: Children were randomized to a control (standard care) or intervention group (standard care + virtual reality). Thresholds for feasibility and acceptability (primary outcomes) were determined through a priori established criteria. The level of procedural pain (principal clinical outcome) and distress, as well as memory of pain at 24 h were collected and reported as medians (Q1, Q3) for each group. RESULTS: 63 patients were enrolled, with a high rate of recruitment (78.8%) and game completion (90.3%). Patients, parents and, healthcare providers reported high satisfaction levels. There were no serious adverse events. Five of the 30 patients (16.7%) exposed to virtual reality reported mild side effects. Self-reported procedural pain (verbal numerical rating scale: 3 (1, 6)/10 vs 3 (1, 5.5)/10, p = 0.75) was similar between groups. Further exploratory clinical measures were reported for the intervention and control groups, respectively: self-rated distress during the procedure (Child Fear Scale: 1 (0, 2)/4 vs 2 (0, 3)/4); distress evaluated by proxy during the procedure (Procedure Behavior Check List: 8 (8, 9)/40 vs 10 (8, 15)/40); memory of pain at 24 h (VNRS: 2 (1, 3)/10 vs 4 (2, 6.5)/10). CONCLUSION: The addition of virtual reality to standard care is feasible and acceptable for pain and distress management during IV procedures in the pediatric ED. Occasional mild, self-resolving side effects were observed in the intervention group. Self-reported pain during the procedure was similar between groups. CLINICALTRIALS. GOV IDENTIFIER: NCT03750578.

RéSUMé: OBJECTIFS: Les procédures intraveineuses (IV) causent de la douleur et de la détresse dans le service des urgences pédiatriques (ED). Nous avons étudié la faisabilité et l'acceptabilité de la distraction en réalité virtuelle pour le confort du patient lors des procédures intraveineuses. LES MéTHODES: Les enfants ont été randomisés dans un groupe de contrôle (soins standard) ou d'intervention (soins standard + réalité virtuelle). Les seuils de faisabilité et d'acceptabilité (résultats primaires) ont été déterminés au moyen de critères établis a priori. Le niveau de douleur procédurale (résultat clinique principal) et de détresse, ainsi que la mémoire de la douleur à 24 heures ont été recueillis et rapportés sous forme de médiane (Q1, Q3) pour chaque groupe. RéSULTATS: 63 patients ont été inscrits, avec un taux élevé de recrutement (78,8 %) et de complétion du jeu (90,3 %). Les patients, les parents et les prestataires de soins de santé ont déclaré des niveaux de satisfaction élevés. Il n'y a pas eu d'événements indésirables graves. Cinq des 30 patients (16,7 %) exposés à la réalité virtuelle ont signalé des effets secondaires légers. La douleur procédurale auto-déclarée (échelle d'évaluation numérique verbale : 3 (1, 6)/10 vs 3 (1, 5,5)/10, p = 0,75) était similaire entre les groupes. D'autres mesures cliniques exploratoires ont été signalées respectivement pour les groupes d'intervention et de contrôle : détresse auto-évaluée pendant la procédure (échelle de peur de l'enfant: 1 (0,2) / 4 vs 2 (0, 3) / 4); détresse évaluée par procuration au cours de la procédure (Procedure Behavior Check List: 8 (8, 9)/40 vs 10 (8, 15)/40) ; mémoire de la douleur à 24 heures (VNRS : 2 (1, 3)/10 vs 4 (2, 6,5)/10). CONCLUSION: L'ajout de la réalité virtuelle aux soins standard est faisable et acceptable pour la gestion de la douleur et de la détresse pendant les procédures IV dans l'urgence pédiatrique. Des effets secondaires occasionnels légers et auto-régulants ont été observés dans le groupe d'intervention. La douleur auto-déclarée pendant l'intervention était similaire entre les groupes.

Parents' perspectives, information needs and healthcare preferences when consulting for their children with bronchiolitis: A qualitative study.

AIM: Bronchiolitis is the leading cause of hospitalisation in infants, but parental experiences have not been well described. This study explored parents' experiences and asked them how they wanted to receive information. METHODS: A qualitative study was conducted in a tertiary paediatric hospital in Québec, Canada. It consisted of semi-structured interviews with 15 parents of 13 children with bronchiolitis. The interview guide was constructed by a multidisciplinary team that included a parent. The interviews, which were transcribed verbatim, were conducted until no new themes emerged. RESULTS: We interviewed eight mothers, three fathers and two couples for 22-70 minutes: six were carried out in person during the bronchiolitis episode, and seven were phone interviews after a median interval time of 107 days. Parents were very worried about their child's health and their lack of knowledge about bronchiolitis contributed to their anxiety. They found education resources informative, but expressed a strong need for support and reassurance from healthcare teams. The two groups provided similar feedback, regardless of when they were interviewed or whether their child was admitted. CONCLUSION: Although bronchiolitis is common in infancy, parental knowledge was low. Standardised educational tools were useful, but insufficient to meet all their needs.