Anxiety Reaction in Children During Cast Removal using Oscillating Saw versus Cast Shear - A Randomised, Prospective Trial

Abstract

Introduction: To compare the anxiety levels demonstrated by children during cast removal procedure between oscillating saw vs cast shear methods. Material and methods: A randomised prospective study of 102 children (mean age 8.3 ± 3.5 years) with fractures involving upper or lower limbs. Children undergoing removal of cast were divided into 2 groups; either by an oscillating saw or a cast cutting shear. The level of anxiety was assessed by recording the heart rate with a portable fingertip pulse oximeter before, during and after removal of the cast. Objective assessment was performed by documenting the fear level on Children’s Fear Scale (CFS). Results: There was a significant increase in the heart rate of children during cast removal while using the oscillating saw compared to cast shear (p<0.05). The noise level produced by the saw exceeded 80 dB (mean 103.3 dB). The fear level was significantly lower in the cast shear group (p<0.05). Conclusion: The noise produced by the oscillating saw was associated with an increased anxiety level in children undergoing cast removal. Cast shear is a simple and inexpensive instrument that can be used for cast removal in overly anxious children.

Interventions to Reduce Pediatric Anxiety During Orthopaedic Cast Room Procedures

“…There was agreement among 2 Level I and 1 Level II studies that noise reduction headphones significantly reduced procedural anxiety 4-6 . One Level II study used casting shears in place of an oscillating saw to reduce procedural volume and found a similar reduction in anxiety 8 . Another Level II study found a significant reduction in anxiety among children exposed to ambient lullaby music in the casting room 7 (Table IV).…”

“…This systematic review and critical analysis of the current literature evaluated several interventions to reduce anxiety among pediatric patients during orthopaedic cast room procedures. Fourteen prospective studies were included that evaluated strategies to reduce anxiety through various methods including physical and technologybased distraction tools and the incorporation of specialist support professionals [4][5][6][7][8]14,[16][17][18][19][20][21][22] . Many of the included studies varied by age group, outcome measure, and cast room procedure performed.…”

“…Three Level I and 2 Level II studies investigated methods to reduce or modify noise levels during the cast room procedures [4][5][6][7][8] . Most of the studies used patient heart rate or mean arterial pressure to measure anxiety.…”

“…Most of the studies used patient heart rate or mean arterial pressure to measure anxiety. However, 2 studies also used validated pain and fear scales including the Faces, Legs, Activity, Cry, Consolability and Children's Fear Scale (CFS) 5,8 . There was agreement among 2 Level I and 1 Level II studies that noise reduction headphones significantly reduced procedural anxiety [4][5][6] .…”

“…Many proposed interventions have focused on targeting the physical components of these procedures. This includes methods such as volume reduction through noisecanceling headphones or ambient lullaby music [4][5][6][7][8] . Others have suggested patients may benefit from children's videos or instructional material before the procedure to improve their understanding of the actions being performed 9 .…”