SpringerLink
Log in

A Prospective Randomized Controlled Trial Using Virtual Reality in Pediatric Pre-intervention Echocardiograms to Decrease Child Anxiety and Fear

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Virtual reality (VR) as a distraction tool decreases anxiety and fear in children undergoing procedures, but its use has not been studied during transthoracic echocardiograms (TTEs). We hypothesized that VR in children undergoing pre-intervention TTEs decreases anxiety and fear and increases TTE study comprehensiveness and diagnostic accuracy when compared with standard distractors (television, mobile devices). Patients (6–18 years old) scheduled for pre-intervention TTEs at Lucile Packard Children’s Hospital in 2021 and 2022 were prospectively enrolled and randomized to VR and non-VR groups. Patients completed pre- and post-TTE surveys using the Children’s Anxiety Meter-State (CAM-S) and Children’s Fear Scale (CFS). Patients, parents, and sonographers completed post-TTE experience surveys. TTEs were reviewed by pediatric cardiologists for study comprehensiveness and compared with electronic medical records for diagnostic accuracy. Among 67 enrolled patients, 6 declined VR, 31 randomized to the VR group, and 30 to the non-VR group. Anxiety (average CAM-S difference 0.78 ± 1.80, p = 0.0012) and fear (average CFS difference 0.36 ± 0.74, p = 0.0005) decreased in both groups. There was no difference between groups in the change in anxiety and fear pre- and post-TTE (p = 0.96–1.00). TTE study comprehensiveness and diagnostic accuracy were high in both groups. Procedure time (time in the echocardiography room) was less for the VR group (48.4 ± 18.1 min) than the non-VR group (58.8 ± 24.4 min), but without a statistically significant difference (p = 0.075). VR is similar to standard distractors and may decrease procedure time. Patients, parents, and sonographers rated the VR experience highly and encouraged its use with future procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

No datasets were generated or analyzed during the current study.

References

  1. Benavidez OJ, Gauvreau K, Jenkins KJ, Geva T (2008) Diagnostic errors in pediatric echocardiography: development of taxonomy and identification of risk factors. Circulation 117:2995–3001. https://doi.org/10.1161/CIRCULATIONAHA.107.758532

    Article  PubMed  PubMed Central  Google Scholar 

  2. Stern KWD, Gauvreau K, Geva T, Benavidez OJ (2014) The impact of procedural sedation on diagnostic errors in pediatric echocardiography. J Am Soc Echocardiogr 27:949–955. https://doi.org/10.1016/j.echo.2014.04.024

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nelson TM, Xu Z (2015) Pediatric dental sedation: challenges and opportunities. Clin Cosmet Investig Dent 7:97–106. https://doi.org/10.2147/CCIDE.S64250

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ganigara M, Srivastava S, Malik P et al (2019) Comparison of chloral hydrate and pentobarbital sedation for pediatric echocardiography. Echocardiography 36:766–769. https://doi.org/10.1111/echo.14301

    Article  PubMed  Google Scholar 

  5. Liu X, Ji J, Zhao G-Q (2020) General anesthesia affecting on develo** brain: evidence from animal to clinical research. J Anesth 34:765–772. https://doi.org/10.1007/s00540-020-02812-9

    Article  PubMed  PubMed Central  Google Scholar 

  6. Grissinger M (2019) Chloral hydrate: is it still being used? are there safer alternatives? P T 44:444–459

    PubMed  PubMed Central  Google Scholar 

  7. Rodriguez CM, Clough V, Gowda AS, Tucker MC (2012) Multimethod assessment of children’s distress during noninvasive outpatient medical procedures: child and parent attitudes and factors. J Pediatr Psychol 37:557–566. https://doi.org/10.1093/jpepsy/jss005

    Article  PubMed  Google Scholar 

  8. Perry JN, Hooper VD, Masiongale J (2012) Reduction of preoperative anxiety in pediatric surgery patients using age-appropriate teaching interventions. J Perianesth Nurs 27:69–81. https://doi.org/10.1016/j.jopan.2012.01.003

    Article  PubMed  Google Scholar 

  9. Wollin SR, Plummer JL, Owen H et al (2004) Anxiety in children having elective surgery. J Pediatr Nurs 19:128–132. https://doi.org/10.1016/s0882-5963(03)00146-5

    Article  PubMed  Google Scholar 

  10. Díaz-Rodríguez M, Alcántara-Rubio L, Aguilar-García D et al (2021) The effect of play on pain and anxiety in children in the field of nursing: a systematic review. J Pediatr Nurs 61:15–22. https://doi.org/10.1016/j.pedn.2021.02.022

    Article  PubMed  Google Scholar 

  11. Richey AE, Hastings KG, Karius A et al (2022) Virtual reality reduces fear and anxiety during pediatric orthopaedic cast room procedures: a randomized controlled trial. J Pediatr Orthop 42:600–607. https://doi.org/10.1097/BPO.0000000000002250

    Article  PubMed  Google Scholar 

  12. Morris LD, Louw QA, Grimmer-Somers K (2009) The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. Clin J Pain 25:815–826. https://doi.org/10.1097/AJP.0b013e3181aaa909

    Article  PubMed  Google Scholar 

  13. Tas FQ, van Eijk CAM, Staals LM et al (2022) Virtual reality in pediatrics, effects on pain and anxiety: a systematic review and meta-analysis update. Paediatr Anaesth 32:1292–1304. https://doi.org/10.1111/pan.14546

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gold JI, Kim SH, Kant AJ et al (2006) Effectiveness of virtual reality for pediatric pain distraction during i.v. placement. Cyberpsychol Behav 9:207–212. https://doi.org/10.1089/cpb.2006.9.207

    Article  PubMed  Google Scholar 

  15. Fonseca A, Qian D, Forbes T et al (2024) Reducing preoperative caregiver anxiety with virtual reality: a pragmatic randomized controlled study. J Patient Exp 11:23743735231220190. https://doi.org/10.1177/23743735231220190

    Article  PubMed  PubMed Central  Google Scholar 

  16. Rodriguez S, Caruso TJ (2022) What every anesthesiologist should know about virtual reality. Paediatr Anaesth 32:1276–1277. https://doi.org/10.1111/pan.14464

    Article  PubMed  Google Scholar 

  17. Wang E, Thomas JJ, Rodriguez ST et al (2021) Virtual reality for pediatric periprocedural care. Curr Opin Anaesthesiol 34:284–291. https://doi.org/10.1097/ACO.0000000000000983

    Article  PubMed  Google Scholar 

  18. Ersig AL, Kleiber C, McCarthy AM, Hanrahan K (2013) Validation of a clinically useful measure of children’s state anxiety before medical procedures. J Spec Pediatr Nurs 18:311–319. https://doi.org/10.1111/jspn.12042

    Article  PubMed  PubMed Central  Google Scholar 

  19. McMurtry CM, Noel M, Chambers CT, McGrath PJ (2011) Children’s fear during procedural pain: preliminary investigation of the Children’s Fear Scale. Health Psychol 30:780–788. https://doi.org/10.1037/a0024817

    Article  PubMed  Google Scholar 

  20. Behera SK, Smith SN, Tacy TA (2017) Impact of accreditation on quality in echocardiograms: a quantitative approach. J Am Soc Echocardiogr 30:913–922. https://doi.org/10.1016/j.echo.2017.06.008

    Article  PubMed  Google Scholar 

  21. Zahedivash A, Chubb H, Giacone H et al (2023) Utility of smart watches for identifying arrhythmias in children. Commun Med (Lond) 3:167. https://doi.org/10.1038/s43856-023-00392-9

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The American College of Cardiology (ACC) Adult Congenital and Pediatric Cardiology Quality Metrics Working Group initiative is acknowledged for the development of TTE study comprehensiveness and diagnostic accuracy quality metrics.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA

    Sarina K. Behera, Rajesh Punn, Christine Be, Sandra Moon, Katie Jo Stauffer, Kelly Thorson, Nora Asi & Leo Lopez

  2. Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA

    Maria Menendez & Michelle Zuniga

  3. Pediatric Cardiology, Palo Alto Medical Foundation, 301, Industrial Road, Level 1, San Carlos, CA, 94070, USA

    Sarina K. Behera

Authors
  1. Sarina K. Behera
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajesh Punn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Menendez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine Be
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandra Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michelle Zuniga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katie Jo Stauffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kelly Thorson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nora Asi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Leo Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have participated in the work, agree with the content of the article, and have read and approved the final version as submitted.

Corresponding author

Correspondence to Sarina K. Behera.

Ethics declarations

Conflict of interest

None of the authors have financial conflicts of interest or funding to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Behera, S.K., Punn, R., Menendez, M. et al. A Prospective Randomized Controlled Trial Using Virtual Reality in Pediatric Pre-intervention Echocardiograms to Decrease Child Anxiety and Fear. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03555-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00246-024-03555-0

Keywords

Search

Navigation