The efficacy of virtual reality on pain and anxiety reduction during needle-related procedures in a pediatric emergency department setting: a systematic review and meta-analysis

Background Needle-related procedures are a common source of pain, anxiety, and fear in pediatric emergency departments (ED), with negative psychological sequelae. Virtual reality (VR) has emerged as a non-pharmacological distraction tool, but its efficacy in the specific, high-stress ED setting requires further synthesis. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of VR for managing needle-related procedural pain and psychological distress in children in the ED. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception until April 2024 for relevant RCTs. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The primary outcomes were self-reported or observed pain and anxiety; secondary outcomes included fear. Results Nine RCTs involving 944 children were included. VR distraction significantly reduced procedural pain (SMD = −0.64, 95% CI: −1.05 to −0.23, I 2 = 81.8%), anxiety (SMD = −0.67, 95% CI: −1.11 to −0.23, I 2 = 83.1%), and fear (SMD = −0.56, 95% CI: −0.77 to −0.36, I 2 = 34.1%) compared to standard care. Sensitivity analyses confirmed the robustness of these findings. High heterogeneity was observed for pain and anxiety outcomes, which may be attributed to variations in VR content (passive vs. interactive), comparator groups, and outcome measurement tools. Conclusion VR is an effective non-pharmacological intervention for alleviating needle-related procedural pain, anxiety, and fear in children within the ED. Despite significant heterogeneity, the consistent beneficial effects support its integration into clinical practice. Future research should focus on standardizing VR protocols and identifying the most effective VR modalities for different pediatric age groups. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251181929 , identifier CRD420251181929.