The effectiveness of distraction as preoperative anxiety management technique in pediatric patients: A systematic review and meta-analysis of randomized controlled trials

Background: Preoperative anxiety in pediatric patients can affect the course of surgery and cause adverse outcomes. Distraction is used as a measure to reduce preoperative anxiety in pediatric patients. Objective: This study aimed to evaluate the effect of distraction on preoperative anxiety in pediatric patients.Methods: We searched randomized controlled trials in databases (PubMed, Embase, Cochrane Library and ProQuest). Relevant studies were included by strict adherence to the inclusion and exclusion criteria, and intervention methods included a variety of distraction measures compared with routine care. The primary outcome was anxiety level after the intervention in holding area and (or) induction room measured by the modified Yale Preoperative anxiety Scale. Two researchers independently screened and extracted relevant data. A random-effects model was utilized to analysis the effect size as there was significant heterogeneity among the included studies. To further explore the reasons for potential heterogeneity and the effects of different distraction interventions, subgroup analysis was performed.Results: Our search retrieved 793 records. 44 trials were included for qualitative analysis, of which 19 randomized controlled trials with 1341 patients were included for meta-analysis. Our study suggested a decreasing anxiety level of 5.34 versus 15.28 points respectively in holding area and induction room, where the distraction interventions group compared to the control group (MD:-5.34, 95% CI:-7.97 to-2.71 at holding aera; MD:-15.28, 95% CI:-21.48 to-9.09 at induction room). According to subgroup analysis, all subgroups showed significant effects of distraction on preoperative anxiety in pediatric patients. However, the heterogeneity between studies was high.Conclusion: Distraction as a preoperative anxiety management technique can benefit pediatric patients undergoing elective surgery, and healthcare personnel can apply preoperatively to alleviate preoperative anxiety in pediatric patients. Registration: not registered. Tweetable abstract: none.