Pediatric Distraction Tools for Prehospital Care of Pain and Distress: A Systematic Review.

CONTEXT: Distraction therapies are widely used in emergency departments to manage pediatric pain and distress. Little is known about which distraction techniques would translate best into the prehospital environment. OBJECTIVE: To identify emergency department-based distraction techniques for managing pain and/or distress in pediatric patients who may be suitable for the prehospital environment. DATA SOURCES: Ovid Medline, Embase, CINAHL, Cochrane library, World Health Organization Clinical Trials Registry and Google Scholar were searched from their beginning to May 2022. STUDY SELECTION: Studies were included if they reported on: (1) distraction techniques, (2) pediatric ED patients, (3) with pain and/or distress, and (4) used interventional or observational study designs. Studies utilizing interventions not feasible in the prehospital setting were excluded. DATA EXTRACTION: Three authors independently assessed eligibility and completed data extraction. RESULTS: The search yielded 4516 records, and 29 studies were included. Risk of bias across all studies was moderate to high. Children were 3 months to 18 years old. Digital, nondigital, and environmental distractors were tested using 12 pain and 15 distress measurement tools. No significant negative outcomes were reported. Fifteen studies reported reductions in self-reported pain and/or distress. Active, nondigital distractors most consistently reduced pain. There was insufficient evidence to support a distraction type for distress. LIMITATIONS: The heterogeneity in study design, distractors, measurement tools, and reporting restricted statistical analysis. CONCLUSIONS: Distraction tools that effectively reduce pediatric pain and/or distress in the ED exist and could be adapted to the prehospital environment. Further research is required to determine feasibility and effectiveness.