Hoe effectief is afleiding als pijnstillende interventie bij kinderen?

Non-pharmacological interventions such as distraction techniques may be used to blunt or alleviate (procedurally related) pain, but prospective studies in children (6-12 year) on its feasibility and the magnitude of its effect remain limited. Thus we documented the influence of TV watching to a film chosen by the child during venipuncture in an ambulatory setting on the pain score reported by the child (VAS_c). Simultaneously, the assessment of this pain as perceived by the parents (VAS_p) or the nurse (VAS _n) was also reported. Based on a prospective, and randomized study in 58 children (6-12 year), we documented a significant difference in VAS _c between the TV watching children and the control group (median 1,7 vs 3,3, p < 0,01). 11/58 reported a VAS_c > 4, with only 2 in the intervention arm of the cohort (p < 0,01). In a logistic regression model (VAS_c > 4), passive distraction was the only significant covariate (OR 7,25; 95% CI 1,4-37,4). Correlation between VAS_c and either VAS_p (1,86) or VAS_n (1,7) was fair (r = 0,74 and r = 0,53 respectively), but interratervariability (κ) poor (κ_o 0,23 and κ_v = 0,31). Although the absolute median difference in VASc during distraction remains limited (-1.6 cm VAS _c), it results in a significantly decreased and clinically relevant VAS_c > 4. Interrater agreement was fair, confirming that hetero-evaluation remains poor.