Virtual Reality Interventions for Pediatric Pain and Anxiety Management During Emergency Department Procedures: A Systematic Review and Meta-Analysis

Abstract

Objectives Virtual reality (VR) is a promising nonpharmacological intervention for managing procedural pain and anxiety in children. Its effectiveness in emergency department (ED) settings, where painful procedures occur under time pressure, remains unclear. This systematic review and meta-analysis evaluated VR’s impact on reducing pain and anxiety during pediatric ED procedures. Methods A systematic search of Embase, PubMed, CINAHL, and Cochrane Library databases from inception to July 14, 2025, identified eligible randomized and nonrandomized studies. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Risk of Bias in Nonrandomized Studies of Interventions. Pain and anxiety outcomes were pooled using a random-effects model, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation framework. Results Sixteen studies including 1929 participants (905 VR, 766 control, 258 active/other interventions) were included, with most focusing on needle-related procedures. VR reduced self-reported peak procedural pain compared to routine care (mean difference (MD) = −0.76, 95% CI [−1.25, −0.27]) and active controls (MD = −0.51, 95% CI [−0.85, −0.17]). VR also reduced self-reported anxiety/fear relative to routine care (MD = −0.78, 95% CI [−1.48, −0.07]) and active controls (MD = −0.59, 95% CI [−1.04, −0.13]). Caregiver-reported pain (MD = −1.22, 95% CI [−2.08, −0.37]) and anxiety/fear (MD = −1.52, 95% CI [−2.7, −0.34]) were similarly improved. Risk of bias was moderate to high. Conclusion VR shows moderate reductions in pediatric procedural pain and anxiety in EDs, though study heterogeneity and methodological limitations reduce confidence in these findings. High-quality trials are needed to confirm effectiveness.