title: Reducing anxiety in the pediatric emergency department: a comparative trial.
abstract: BACKGROUND
  Anxiety among patients in a pediatric emergency department (PED) can be significant, but often goes unaddressed.
  
  
  OBJECTIVE
  Our aim was to determine whether exposure to Child Life (CL) or hospital clowning (HC) can reduce anxiety in children presenting to a PED.
  
  
  METHODS
  Patients were randomized to CL, HC, or control and assessed upon entry to examination room (T1), before physician arrival (T2), and during physician examination (T3), using the modified Yale Preoperative Anxiety Scale (m-YPAS). CL and HC interventions occurred for 5 to 10 min before physician entry. Effects were analyzed using mixed analysis of variance.
  
  
  RESULTS
  m-YPAS scores ranged from 23 to 59, with a higher score indicating increased anxiety. Mixed analysis of variance on the study sample (n = 113) showed a significant interaction between groups (CL, HC, control) and time (p = 0.02). Additional analyses indicated effect of group only at T2 (CL: mean = 23.8; 95% confidence interval [CI] 23.2-24.5; HC: mean 25.2; 95% CI 24.2-26.2; control: mean = 26.1; 95% CI 24.2-27.9; p = .02). Subanalysis of patients with T1 m-YPAS score ≥ 28 (n = 56) showed a significant interaction between group and time (p = 0.01). Additional analysis showed effect of group only at T2 (CL: mean 24.4; 95% CI 23.3-25.6; HC: mean 27.0; 95% CI 25.2-28.7; control: mean 29.2; 95% CI 25.6-32.7; p = 0.003).
  
  
  CONCLUSIONS
  CL services can reduce state anxiety for patients presenting to a PED with heightened anxiety at baseline. This reduction occurred immediately after CL intervention, but was not observed in patients exposed to HC or during physician examination.
authors.affiliation: Department of Pediatrics, The University of Chicago Medicine, Comer Children's Hospital, Section of Pediatric Emergency Medicine, Chicago, Illinois.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Heilbrunn
authors.affiliation: Clinical Trials Unit, Children's Hospital, Los Angeles, California.
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Wittern
authors.affiliation: Clinical Trials Unit, Children's Hospital, Los Angeles, California.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Division of Emergency and Transport Medicine, Children's Hospital, Los Angeles, California.
authors.forename: Phung K
authors.initials: PK
authors.lastname: Pham
authors.affiliation: Children's Orthopedic Center, Children's Hospital, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Anita H
authors.initials: AH
authors.lastname: Hamilton
authors.affiliation: Division of Emergency and Transport Medicine, Children's Hospital, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Nager
mesh_terms: D000704:Analysis of Variance; D001007:Anxiety / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D010353:Patient Education as Topic; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016037:Single-Blind Method; D014925:Wit and Humor as Topic
keywords: Child Life; emergency department; hospital clowning; pediatrics; state anxiety