P48
DEVELOPMENT AND INTRODUCTION OF A MIXED REALITIES PLAYKIT: DECREASING THE INCIDENCE OF GENERAL ANAESTHESIA FOR PAEDIATRIC MRI
L. Murray1, J. Thompson2, D. Yamada-Rice3, S. Thompson4, M Taylor1
1Sheffield Children's Hospital, UK
2University of Sheffield, UK
3School of Art, Design and Architecture, The University of Plymouth, Plymouth, UK
4Dubit UK, Leeds, UK
Introduction
An augmented reality (AR)/virtual reality (VR) combined with physical play playkit has been developed to help reduce the incidence of general anaesthesia (GA) for MRI imaging in children aged 4-10. The kit includes a flat-packed cardboard model scanner which children build with parents/carers, allowing familiarisation with the scanner, opportunities to practise staying still, preparation for high noise levels and simulation of the entire process through a series of interactive VR games. A smartphone is inserted into the 'scanner', and 'images' generated via an app (Figure 1). Also included is a cardboard VR headset which enables a 'walkthrough' of the process.
Methods
Playkit development: initial concept research with primary school children; exploring parental perspectives through a questionnaire; character design development with children; user testing with non-patients; full playkit testing with patients (n=13) and parents/carers. Children were recruited via Sheffield Children’s Hospital and sent the playkit a week before their scan. Online interviews with the research team, children and parents/carers were undertaken before the scan and 1 week afterwards. Children were asked about their experiences of the scan and aspects of the playkit they found useful in preparation. Online interviews were transcribed and analysed using thematic framework analysis. (Full methods available).
Results
Interview data suggested the playkit helped some children (and parent/carers) to prepare for an MRI without GA and helped relieve anxiety during the scan. In post-scan interviews children said that recalling aspects of the playkit during their scan helped them remain calm and still. There appeared to be differences across the age spectrum, with older children seemingly preferring VR aspects and younger children drawn to the physical play aspects of the kit. Further research may help to explore this.
Discussion
This playkit addresses a significant problem within paediatric anaesthesia and presents an opportunity for a change in practice to reduce the number of paediatric GAs and improve efficiency and resource usage. Although evidence is lacking on harmful effects of repeated GAs in childhood, human cohort studies have suggested that repeated GAs in children may lead to adverse neurodevelopmental effects. (1) We suggest that reducing GA rates for MRIs presents a clear benefit, avoiding the requirement of GA for a non-invasive procedure by alleviating anxiety. The AR/VR/physical MRI playkit may also have a compound benefit effect on children requiring repeated MRI scans; further research is needed to assess this.
Future directions of this novel project may include a possible extension of this concept to other aspects of anaesthetic care—for example, to help prepare children for elective surgery. Following the positive qualitative results of this local project, we suggest a trial across anaesthetic departments nationally and internationally, and encourage the uptake and rollout of the MRI playkit on a wider scale.
Reference:
- McCann ME, de Graaff JC, Dorris L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet 2019;393:664–77. doi:10.1016/S0140-6736(18)32485-1