551 - Determining the Efficacy of Magic Distraction Therapy to Alleviate Pediatric Patient and Caregiver Anxiety in the Emergency Department

Publication Number: 2536.551

Jacky D. Lin, Renaissance School of Medicine at Stony Brook University, Jericho, NY, United States; Michelle Khattri, Renaissance School of Medicine at Stony Brook University, Port Jefferson Station, NY, United States; Anthony J. Sochan, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Maryam Tayyab, Renaissance School of Medicine at Stony Brook University, Hauppague, NY, United States; Saba Gulzar, Renaissance School of Medicine at Stony Brook University, New Hyde Park, NY, United States; Janica Ha, Renaissance School of Medicine at Stony Brook University, Port Jefferson Station, NY, United States; Aaron Lopez, Renaissance School of Medicine at Stony Brook University, Great Neck, NY, United States; Anthony G. Chesebro, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States; Brandon J. Wong, University of California, Irvine, School of Medicine, Santa Ana, CA, United States; Anne Bennett, University of Texas Southwestern Medical School, Dallas, TX, United States; Harrison Pravder, Massachusetts Eye and Ear Infirmary, Boston, MA, United States; Carl Kaplan, Renaissance School of Medicine at Stony Brook University, Old Bethpage, NY, United States

Background: Anxiety in pediatric patients during invasive procedures poses a significant obstacle in delivering medical care, prolonging procedure times and increasing risk of accidental injury. Prior research has demonstrated the efficacy of magic distraction therapy (MDT) to alleviate anxiety in the inpatient setting by as much as 24%. The efficacy of MDT has not been characterized in the Pediatric Emergency Department (PED).

Objective: To assess the effect of MDT on pre-adolescent and adolescent patient and caregiver peri-procedural anxiety in the PED.

Design/Methods: This IRB-approved study included PED patients 5-16 years old undergoing needlestick procedures and their caregivers. After obtaining consent, patients were randomized to either the experimental group (MDT administered during procedure) or the control group (standard child life distraction).

Patient anxiety was measured using: the Visual Analogue Scale (VAS), the Face, Legs, Activity, Cry, and Consolability Scale (FLACC), and the Faces Pain Scale (FPS). All scales were completed by the patient pre- and post-procedure. Caregiver anxiety was measured with a pre- and post-procedure VAS, and an initial Short Term Anxiety Inventory (STAI) (Figure 1). MDT performed aligned with the standard MagicAid curriculum and was individualized for the patient's age. Statistical analyses were completed using MATLAB R2021a.

Results: Forty-two patients were enrolled and randomized into the 2 groups (19 MDT, 23 control) and demographics reported (Table 1). In both groups, patients experienced a significant decrease in anxiety post-procedure compared with pre-procedure across all evaluation tools (p < 0.05) (Table 2). Caregiver anxiety, measured by the VAS, was significantly lower after the procedure in the MDT group (p < 0.001) but not the control group (p=0.06), although with no significant difference between the two groups (p=0.1). Anxiety was equally reduced for older and younger children, and no correlation to previous needlesticks or previous ED visits was found (p>0.05). Caregivers did report higher anxiety scores if their child had had a previous needlestick experience (p=0.04).

Conclusion(s): MDT, similar to established child life distraction methods, provides a significant decrease in anxiety for both the child and caregiver. Efficacy of MDT was independent of patient age, bolstering its applicability across childhood. MDT is an effective and low-cost intervention to alleviate pediatric anxiety during needlestick procedures in the PED. In future studies, we aim to further explore MDT's utility across other PED scenarios which may cause patient anxiety.

Figure 1. Flowchart of Patient Randomization and Timeline of Anxiety Evaluation Tools.
All assessment tools were completed regardless of randomization. Three anxiety assessment tools (FLACC, FPS, and VAS) related to the child were completed pre-procedurally and post-procedurally. Caregiver anxiety was evaluated using VAS pre-procedurally and post-procedurally, and an initial STAI. Additional assessments for demographics and satisfaction were also completed pre-procedure and post-procedure respectively.

Table 1: Patient Demographics amongst Experimental vs Control Groups
Patient demographics were evaluated prior to randomization. Analysis of gender, age, prior ED visits, and prior needle procedures indicates successful randomization and a non-significant difference between groups. Age analysis was assessed by an unpaired two-tailed t-test (p-values > 0.05). Gender distribution, prior ED visits, and prior needle procedures analyses were assessed by chi-squared test (p-values > 0.05).

Table 2. Anxiety Scores Pre- and Post-Needlestick Procedure for Each Evaluation Assessment
Caption: Mean anxiety scores across all evaluation tools in both the experimental and control group were reduced for the patient post-procedurally. Intra-group analysis was assessed using a paired two-tail t-test; inter-group analysis was assessed by an unpaired two-tailed t-test. p-values < 0.05 were considered statistically significant and are highlighted in bold.