Newsletters

POSTED: December 26th, 2020
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, November/December 2020,

Research conducted by: Cara Watson, MD; Timothy Koboldt, MD, FACEP; Julie Stilley, PhD; Kyle Kaletka, M2

This research project was partially funded by the 2019 MOCEP Resident Research Grant. Find out more about the Resident Research Grant here. You can view the poster presentation in video format here.

Introduction

Incision and drainage and laceration repair can be particularly painful procedures in the Emergency Department for pediatric and adult patients alike. With the advancement of technology, and the ability to acquire affordable, high-quality software, Child Life specialists have already started to make an impact with patient comfort and satisfaction in the form of iPads with videos, music, and games.

Our hypothesis is that we can increase comfort, increase anxiolysis, and decrease pain by implementing Virtual Reality (VR) software in the ED during painful procedures. In a pilot study (n=10), 90% of participants found VR headsets to be an effective distraction tool. With the proper gear and software, we hope to apply a high-quality VR experience to adult and pediatric patients in order to improve comfort and decrease negative side-effects experienced during painful procedures as compared to those undergoing the standard I&D or laceration repair without VR implementation.  

Methods

Our study is a multi-centered study with patients selected from both University Hospital (UH) and Women’s and Children’s Hospital (WCH). Our goal is to have 20 patients enrolled in each arm, with a total of 80 patients enrolled. This includes children aged 6-17 and adults undergoing I&D or laceration repair in the ED. Exclusion criteria include those with facial abscess/laceration, nausea or vomiting, legal blindness, or in whom those assent/consent cannot be obtained. Our study is randomized, with adults and children assigned to intervention and control groups based on the day of the week.

Four VR headsets were purchased with grant funds, two headsets stationed at UH and two at WCH, in addition to software for applications used on the headset itself that patients access in ED.

Results

We have enrolled 48 adult patients in the study, with only a few remaining needed to complete the intervention arm. Further pediatric enrollment is required before data can be analyzed for that branch. Early data has shown that there is a statistically significant change in anxiety between scores gathered pre- and post-procedure, a decrease of 14.6 on the VAS in the VR group (p=0.047). compared to an increased in reported anxiety score in the non-VR arm. There was not a statistically significant change in pain pre- and post-procedure with both groups having an increased pain score post-procedure (p= 0.916).

Conclusion

Low-cost Virtual Reality as used in this study shows promise for reduction in anxiety during painful procedures, however data does not demonstrate a change in pain when comparing the intervention vs. the control based on current patient models. Further enrollment of pediatric patients will be required to determine the effect of this intervention for children.