O3259: Easing the Ouch: Evaluating the Efficacy of Child Life Services on Reducing Stress During Pin Removal

Background: Child Life Services (CLS) provide supportive interventions to help minimize patient anxiety with various clinical procedures. This investigation sought to determine the efficacy of CLS intervention for the removal of percutaneous pins following upper extremity fracture fixation and guide potential areas to focus CLS resources.

Methods: This was a non-randomized, prospective study of pediatric patients aged 5-12 years presenting to a single tertiary-care institution from 2022-2025 for the removal of percutaneous pins following upper extremity fracture fixation. Subjects were divided into “CLS” and “No CLS” groups based on the availability of CLS resources at the time of their pin removal procedure. Prior to the procedure, both subjects and their parents completed PROMIS Anxiety surveys and provided a baseline Thermometer Stress Score on a 0-10 scale. A “FLACC” score, a 0-10 scale reflecting the patients’ facial expression, leg position, activity, crying, and consolability during the procedure, was taken. After the pin(s) were removed, both patients and parents completed a second Thermometer Stress Score, and parents completed an optional satisfaction score (0-100 scale). Descriptive statistics were tabulated and differences across groups were analyzed utilizing Mann-Whitney tests. Further analysis was conducted by sub-groups based on patient age and baseline anxiety.

Results: In total, 152 patients (87, 57.2% male) with a mean age of 7.6  2.2 years at pin removal were included for analysis. CLS was present for 86 (56.6%) patients and absent for 66 (43.4%). The supracondylar humerus (87, 57.22%) was the most common fracture site for percutaneous pin removal, followed by phalangeal fractures (36, 23.7%). Within the full cohort, no differences were found across “CLS” and “No CLS” groups. However, further sub-analysis by age demonstrated that for patients aged 5-7 years old, their post-procedure stress, as measured by the Thermometer Stress Score, was significantly higher when CLS was not present (5.6  3.5 versus 3.9  3.3, p=0.025). Further, patients that indicated a higher baseline anxiety, as measured by the pre-procedure PROMIS Anxiety survey, showed increased stress prior to the procedure when CLS was not present (5.1  2.3 versus 3.7  2.2, p=0.021). No significant differences were found across “CLS” versus “No CLS” groups in older (8-12 years) or non-anxious patients. Parents showed no differences in stress across groups before or after the procedure, regardless of patient age or anxiety. Differences across groups are further described in Table 1.

Conclusion: CLS interventions prove effective for a subset of patients undergoing the removal of percutaneous pins following upper extremity fixation. Specifically, younger, more anxious patients appear to experience less distress with CLS intervention during upper extremity pin removals. Sample size limited more detailed sub-group analysis, so further research should continue to explore the efficacy of CLS in younger and anxious patients.