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An Evaluation of High Preprocedural Anxiety and Venipuncture Pain Experienced by Young Children

Objective The aim of this study was to determine if young children with high preprocedural anxiety experience increased pain at venipuncture. Methods This was secondary analysis of prospectively obtained data from a randomized controlled trial comparing vapocoolant spray with jet-injected lidocaine for venipuncture pain. Children aged 1 to 6 years were enrolled and videotaped. Videos were reviewed and scored for anxiety using the modified Yale Preoperative Anxiety Scale score for preprocedural anxiety (score range, 23–100). High anxiety was defined as greater than 40. Pain at the time of venipuncture was scored using the Face, Legs, Activity, Cry, and Consolability scale (score range 0–10). Moderate to severe pain was defined as greater than 3. Logistic regression assessed patient factors associated with high preprocedural anxiety and evaluated the relationship between preprocedural anxiety and pain during venipuncture. Results Two hundred five patients were enrolled; 59.5% of patients were male, and 53.7% were White. Mean age was 3.2 years. Prior to the procedure, 67% of patients had high anxiety. Patient age, race, sex, and previous venipuncture were not associated with increased odds of high anxiety. Moderate to severe pain at venipuncture was observed in 65% of children. High preprocedural anxiety was associated with increased odds of moderate to severe pain at venipuncture when controlled for patient characteristics (adjusted odds ratio, 4.62; 95% confidence interval, 2.03–8.54). Conclusions Most young children undergoing venipuncture experienced high preprocedural anxiety. Children with high preprocedural anxiety had increased odds of moderate to severe pain at venipuncture. Anxiety-reducing interventions should be explored to reduce pain experienced during venipuncture.