80 Distraction in the ED using Virtual reality for Intravenous Needs in Children to Improve comfort -the DEVINCI project: A Pilot RCT
Notice bibliographique
Résumé
Abstract Background Venipuncture is a frequent cause of pain and distress in the pediatric emergency department (ED). Healthcare professionals must optimize patient comfort during such procedures, given the associated short- and long-term adverse events. Distraction, which can improve patient experience, remains the most studied psychological intervention. Virtual reality (VR) is a method of immersive distraction that can contribute to the multi-modal management of procedural pain and distress. Its use in the healthcare setting has become more accessible due to the development of more portable and affordable systems. Objectives The primary outcome of this study was to determine the feasibility and acceptability of a VR distraction device in the pediatric ED. The secondary outcomes were to examine the preliminary effects of the addition of VR to standard practice on children’s pain, distress, and memory of pain associated with venipunctures in the pediatric ED. Design/Methods This pilot RCT was performed at a tertiary pediatric centre. Children 7-17 years old requiring a venipuncture in the ED were recruited. Participants were randomized to either a control group (standard care) or intervention group (standard care+VR). A priori feasibility and acceptability criteria were established following expert consensus (nurses/physicians working in the ED): - 80% of families approached for recruitment consent to participate; - 80% of recruited patients finish the game as planned (intervention group); - Mean >7 on the 0-10 satisfaction scale (patients/parents/healthcare providers); - No serious adverse events. The principal clinical outcome was the mean level of procedural pain as measured by the verbal numerical rating scale (VNRS). Auto-evaluation of procedural-related distress was performed using the Child Fear Scale (CFS). The level of distress related to the procedure was also evaluated by proxy using the Procedure Behavior Check List (PBCL). Memory of pain was measured at 24h using the VNRS. Side effects were documented. Results A total of 63 patients were recruited between December 2018 and April 2019 (one was excluded as the venipuncture was later cancelled). The results showed feasibility and acceptability of VR in the pediatric ED with: -79% recruitment rate of eligible families -90% rate of VR game completion as per protocol (reason for not completing the game: prior headache, wanting to see, VR not working well) and -overall high mean satisfaction levels. In addition, there was a significantly higher level of satisfaction among healthcare providers in the intervention group, and 93% of those were willing to use this technology again for the same procedure. Regarding clinical outcomes, there was no significant difference between groups in self-reported procedural pain, but evaluation of distress by proxy (10/40 vs 13.2/40, p = 0.007) and memory of pain at 24 hours (2.4 vs 4.2, p = 0.027) were significantly lower in the intervention group. Venipuncture was successful on first attempt in 23/31 patients (74%) in the VR group and 15/30 (50%) patients in the control group (p = 0.039). Five of the 31 patients (16%) in the VR group reported side effects, which were mild and self-resolving. Conclusion The addition of VR to standard of care for pain and distress management related to venipunctures in the pediatric ED is a feasible and acceptable intervention. Side effects related to VR were few and self-resolving. Both experimental groups were similar with respect to self-reported procedural pain. A lower level of procedural distress, lower memory of pain at 24 hours, and higher venipuncture first attempt success rate were observed in the VR group.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».