Virtual Reality Versus Game Card Distraction During Pediatric Wound Care

Open wound care procedures may cause fear, anxiety, pain, and physiological stress in children. This study was conducted in the pediatric emergency department of Ağrı Training and Research Hospital, Turkey, between April and May 2023.

Children aged 5-10 years who required open wound care were randomly allocated in a 1:1:1 ratio to standard care alone, standard care plus distraction game cards, or standard care plus immersive virtual reality. Standard care included wound cleansing, debridement, suturing when clinically indicated, and dressing.

In the game card group, a trained researcher used laminated illustrated cards with visual-search and pattern-recognition tasks and provided structured prompts throughout the procedure. In the virtual reality group, children viewed a preset sequence of passive, non-interactive, age-appropriate 360-degree three-dimensional audiovisual videos using a smartphone-based virtual reality headset throughout the procedure.

Fear, state anxiety, pain, heart rate, and peripheral oxygen saturation were measured immediately before wound care and within 5 minutes after completion. The study compared psychological and physiological responses among the three groups.

Inclusion criteria

• Aged 5-10 years
• Presented with an open wound requiring cleansing, dressing, debridement, and/or suturing
• Hemodynamically stable at baseline, with peripheral oxygen saturation of at least 95 percentage and heart rate within age-appropriate limits
• Able to communicate sufficiently to complete the study assessments
• Written informed consent provided by a parent or legal guardian
• Verbal assent provided by the child

Exclusion criteria

• Neurodevelopmental or communication disorder that could interfere with study assessments
• Significant visual or hearing impairment
• Head or facial wound preventing use of the virtual reality headset
• History of motion sickness or a previous adverse reaction to virtual reality
• Receipt of sedatives or systemic opioid analgesics within 6 hours before the procedure
• Requirement for procedural sedation during wound care
• Any clinical condition judged by the attending physician to make participation inappropriate