gms | German Medical Science

Objectives/Interrogation: Cast immobilization of pediatric and adolescent fractures is the mainstay of treatment for the vast majority of fractures. However, cast removal may cause the child to be anxious making the removal difficult and potentially leading to an adverse complication during the removal. Previous studies have demonstrated reduced anxiety utilizing art and music therapy, however this requires substantial resources and may not be possible in the outpatient setting. The purpose of this study was to prospectively determine the effectiveness of visual stimulation utilizing a parent's cell phone or hand-held device to determine if this "no cost" alternative can reduce anxiety during cast removal.

Methods: A prospective study was performed to enroll all pediatric patients that presented in the outpatient setting for cast removal. Blood pressure and heart rate were recorded using an automated sphygmomanometer and the child's Faces score was assessed. Measurements of these proxies for anxiety were performed in the waiting area prior to cast removal, in the cast room during cast removal, and in the cast room 5 minutes following cast removal. Patients were randomized to utilize their parent's mobile device or not. Repeated measures mixed effect models were used to determine the effect of the mobile device to reduce the patient's heart rate and blood pressure compared to the control group. A student t-test was used to determine the effect of the intervention of the Faces score.

Results and Conclusions: Fifty patients were randomly assigned to either the experimental group (n=21) or the control group (n=29) via REDCap survey. Despite adequate power, no statistically significant difference was present in the heart rate (p=0.82), systolic blood pressure (p=0.45), and Faces score (p=0.06) between the groups.

Using a parent's mobile device to distract a child during cast removal did not reduce anxiety. Alternative methods such as music and art therapy may be better suited to reduce anxiety during cast removal, but these methods require substantial resources. Future studies are needed to identify a low cost alternative to reduce anxiety during cast removal. Mobile cell phones and personal electronic devices are not effective at reducing anxiety during cast removal and therefore we cannot recommend them as an alternative low-cost distractor.