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Pediatric Distraction Tools for Prehospital Care of Pain and Distress: A Systematic Review
Natasha Robinson1, Ashleigh Delorenzo1,2, Stuart Howell1
1Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
Insights
Active, non-digital distraction methods effectively reduce pediatric pain in emergency departments and may be adaptable for prehospital use. Further research is needed to confirm effectiveness for distress.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Prehospital Care
Background:
- Distraction therapies are common in emergency departments (EDs) for pediatric pain and distress.
- Limited understanding exists regarding the applicability of these techniques in the prehospital setting.
Approach:
- A systematic literature search was conducted across multiple databases (Ovid Medline, Embase, CINAHL, Cochrane, WHO ICTR, Google Scholar) up to May 2022.
- Included studies focused on distraction techniques for pediatric patients (3 months–18 years) experiencing pain/distress in EDs, excluding prehospital-infeasible interventions.
- Data extraction and eligibility assessment were performed independently by three authors.
Key Points:
- Twenty-nine studies involving 4516 records were analyzed, with moderate to high risk of bias.
- Active, non-digital distractors demonstrated the most consistent reduction in self-reported pediatric pain.
- Evidence for distraction techniques effectively reducing pediatric distress in the prehospital setting was insufficient.
Conclusions:
- Existing ED distraction tools show potential for adaptation to the prehospital environment.
- Heterogeneity in study designs and outcome measures limited statistical analysis.
- Further research is essential to establish the feasibility and effectiveness of these techniques in prehospital pediatric care.
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.
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