Ali Samina, Ma Keon, Dow Nadia, Vandermeer Ben, Scott Shannon, Beran Tanya, Issawi Amir, Curtis Sarah, Jou Hsing, Graham Timothy A D, Sigismund Leanne, Hartling Lisa
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.
Women & Children's Health Research Institute, Edmonton, Alberta.
Paediatr Child Health. 2020 Aug 20;26(5):287-293. doi: 10.1093/pch/pxaa089. eCollection 2021 Aug.
We compared the addition of iPad distraction to standard care, versus standard care alone, to manage the pain and distress of intravenous (IV) cannulation.
Eighty-five children aged 6 to 11 years requiring IV cannulation (without child life services present) were recruited for a randomized controlled trial from a paediatric emergency department. Primary outcomes were self-reported pain (Faces Pain Scale-Revised [FPS-R]) and distress (Observational Scale of Behavioral Distress-Revised [OSBD-R]), analyzed with two-sample t-tests, Mann-Whitney U-tests, and regression analysis.
Forty-two children received iPad distraction and 43 standard care; forty (95%) and 35 (81%) received topical anesthesia, respectively (P=0.09). There was no significant difference in procedural pain using an iPad (median [interquartile range]: 2.0 [0.0, 6.0]) in addition to standard care (2.0 [2.0, 6.0]) (P=0.35). There was no significant change from baseline behavioural distress using an iPad (mean ± SD: 0.53 ± 1.19) in addition to standard care (0.43 ± 1.56) (P=0.44). Less total behavioural distress was associated with having prior emergency department visits (odds ratio [95% confidence interval]: -1.90 [-3.37, -0.43]) or being discharged home (-1.78 [-3.04, -0.52]); prior hospitalization was associated with greater distress (1.29 [0.09, 2.49]). Significantly more parents wished to have the same approach in the future in the iPad arm (41 of 41, 100%) compared to standard care (36 of 42, 86%) (P=0.03).
iPad distraction during IV cannulation in school-aged children was not associated with less pain or distress than standard care alone. The effects of iPad distraction may have been blunted by topical anesthetic cream usage.
ClinicalTrials.gov: NCT02326623.
我们比较了在标准护理基础上加用iPad分散注意力与单纯标准护理对静脉（IV）置管时疼痛和痛苦的影响。
从儿科急诊科招募了85名6至11岁需要进行IV置管（无儿童生活服务人员在场）的儿童，进行一项随机对照试验。主要结局指标为自我报告的疼痛（面部疼痛量表修订版[FPS-R]）和痛苦（行为痛苦观察量表修订版[OSBD-R]），采用两样本t检验、曼-惠特尼U检验和回归分析。
42名儿童接受了iPad分散注意力干预，43名接受标准护理；分别有40名（95%）和35名（81%）接受了局部麻醉（P = 0.09）。在标准护理基础上加用iPad时的操作疼痛（中位数[四分位间距]：2.0[0.0，6.0]）与单纯标准护理时（2.0[2.0，6.0]）相比无显著差异（P = 0.35）。在标准护理基础上加用iPad时的行为痛苦与基线相比（均值±标准差：0.53±1.19）与单纯标准护理时（0.43±1.56）相比无显著变化（P = 0.44）。总行为痛苦较少与之前去过急诊科（比值比[95%置信区间]：-1.90[-3.37，-0.43]）或出院回家（-1.78[-3.04，-0.52]）有关；之前住院与更大的痛苦有关（1.29[0.09，2.49]）。与标准护理组（42名中的36名，86%）相比，iPad组中希望未来采用相同方法的家长明显更多（41名中的41名，100%）（P = 0.03）。
学龄儿童IV置管期间使用iPad分散注意力与单纯标准护理相比，并未减少疼痛或痛苦。局部麻醉膏的使用可能削弱了iPad分散注意力的效果。
ClinicalTrials.gov：NCT02326623。
