Children Referred to the Pediatric Emergency Department Clinical Trial
Official title:
The Effect of Medical Clowns on Blood Pressure Measurement in Children Presenting to the Emergency Department
Obtaining vital signs and blood pressure (BP) in particularly, as part of a pediatric
Emergency Department (ED) patient triage is sometimes difficult and leads to many false
negative results.
The stress, noisy environment and lack of cooperation are only a few of the things that
interfere with proper vital signs measurements.
In the past decade, there has been a rapid growth in the presence of therapeutic clowns in
hospitals, particularly in pediatric settings.
The investigators speculate that the incorporation of a medical clown during the procedure of
blood pressure measurement in the triage will shorten the procedure and decrease the number
of attempts, making it much more efficient.
Blood pressure is measured in the triage amongst most children presented to the Pediatric ED.
There are many barriers to obtaining an accurate BP measurement in children, including
inappropriate technique, lack of equipment, but also - pain, and the child's
uncooperativeness or anxiety. The latter may even be accentuated in an ED setting.
These factors may lead to falsely elevated BP readings, which may provoke significant anxiety
in children and families and possibly lead to a cascade of unnecessary investigation and
consultations.
Additionally, an abnormal measured BP value routinely mandate an additional measurement
attempt which itself may cause anxiety and restlessness among children, especially toddlers
and infants, and prolongs the entire triage process.
The Second Task Force Report on Blood Pressure Control in Children emphasizes taking blood
pressure measurements in a quiet environment, using a proper size cuff and using appropriate
technique. Ideally, BP should be measured several times in a a relaxed child and in a quiet
setting, however this scenario is nearly impossible in the ED, as demonstrated in a previous
retrospective study that indicated that although BP was elevated in 52% of children who
underwent triage blood pressure measurement in the ED, the measurement was repeated in only
38%.
In the past decade, there has been a rapid growth in the presence of therapeutic clowns in
hospitals, particularly in pediatric settings. A recent study conducted in a pediatric ED in
Israel has demonstrated the benefit of medical clowns in diminishing pain and anxiety during
painful procedures being performed on children in the ED.
Previous studies conducted in our institute have demonstrated a beneficial effect on vital
signs (blood pressure and heart rate) as a sign of decreased anxiety following the
incorporation of a medical clown in a multisystem team caring for pediatric patient.
Blood pressure measurement among pediatric patients, although not a painful procedure, may
cause a stressful reaction, prolonging the entire process and requiring additional attempts -
making it a time consuming task in a busy ED.
A medical clown may have a beneficial effect on the pediatric patient by decreasing the
stress reaction and may therefore shorten the entire process making it much more efficient.
The investigators are unaware of any studies conducted related to the effect of the use of
medical clowns during ED blood pressure measurements in the triage.
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