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Digital Technology Distraction for Acute Pain in Children: A Meta-analysis.

Pediatrics 2020 Februrary
CONTEXT: Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown.

OBJECTIVE: To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures.

DATA SOURCES: Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources.

STUDY SELECTION: Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children.

DATA EXTRACTION: Performed by 1 reviewer with verification. Outcomes were child pain and distress.

RESULTS: There were 106 studies ( n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care.

LIMITATIONS: Few studies directly compared different distractors or provided subgroup data to inform applicability.

CONCLUSIONS: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.

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