Virtual reality-based distraction for intravenous insertion-related distress in children: a study protocol for a randomised controlled trial

Abstract

Introduction: Intravenous (IV) insertions are among the most performed procedures for children seeking medical care; they are often a painful and stressful experience for both children and their caregivers. Paediatric distress and pain that is inadequately treated may lead to a frightened and uncooperative child, repeated IV attempts and overall frustration with care for both the family and clinical team. We hypothesise that distraction via an immersive virtual reality (VR) experience may reduce the associated distress for children undergoing IV insertions.

Methods and analysis: This two-armed randomised controlled superiority trial will be conducted in a Canadian paediatric emergency department and will aim to enrol 80 children overall. Children will be randomised to receive either departmental standard of care alone or standard of care plus an immersive VR experience. Children 6-17 years of age who are undergoing IV insertion and have topical anaesthetic application will be considered for inclusion. Our primary objective is to compare the reduction of distress between the two study arms. The primary outcome will be the child's observed distress score as measured by the Observational Signs of Behavioral Distress-Revised tool. Secondary outcomes include the child's pain intensity and fear, parental anxiety, satisfaction with the IV procedure, as well as adverse events. Recruitment launched in September 2020 and is expected to end in March 2022.

Ethics and dissemination: This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent will be obtained from parents or guardians, and assent from children. Study data will be submitted for publication irrespective of results. This study is funded through a Women and Children's Health Research Institute Innovation grant. Purchase of the VR equipment was facilitated through a Stollery Children's Hospital Foundation small equipment grant.

Trial registration number: NCT04291404Cite Now.

Keywords: ACCIDENT & EMERGENCY MEDICINE; PAIN MANAGEMENT; Paediatric A&E and ambulatory care; Pain management.

Figure 1

Child using virtual reality goggles in the emergency department.

Figure 2

Virtual reality (VR) game menus.

Figure 3

Flow diagram of study procedures. OSBD-R coding of videos will be done by RAs post-visit. BARF, Baxter Retching Faces; CFS, Children’s Fear Scale; HR, heart rate; IV, intravenous; OSBD-R, Observational Scale of Behavioral Distress-Revised; RAs, research assistants; STAI-S, State Trait Anxiety Inventory–State Scale Revised Version; vNRS, verbal Numerical Rating Scale; VR, virtual reality.