Anna Taddio1, Horace Wong2, Ben Welkovics2, Angelo L Ilersich2, Mara Cole3, Morton Goldbach3, Moshe Ipp4. 1. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Electronic address: anna.taddio@utoronto.ca. 2. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario M5S 3M2, Canada. 3. Paediatric Associates, 90 Warren Road, Suite 103, Toronto, Ontario M4V 2S2, Canada. 4. Paediatric Associates, 90 Warren Road, Suite 103, Toronto, Ontario M4V 2S2, Canada; Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Abstract
OBJECTIVE: This study compared the pain caused from fast vs. slow vaccine injections. METHODS:Infants aged 2-6months receiving primary immunizations were randomized to fast (2-4mL/s) or slow (5-10mL/s) injections during routine 0.5mL Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) injections. Those aged 2 and 4months additionally received 0.5mL Pneumococcal Conjugate Vaccine (PCV) injections. A research assistant and parent unaware of treatment allocation and hypothesis assessed pain using validated and recommended tools, including; the Modified Behavioural Pain Scale (MBPS, range 0-10), cry duration, and Numerical Rating Scale (NRS, range 0-10). The primary outcome was infant pain score using the MBPS. RESULTS: Altogether, 120 were recruited; 61 were randomized to fast injections and 59 to slow injections. One hundred and ninteen infants participated. There were no differences in characteristics, including; age (p=0.994) and sex (p=0.540). The mean MPBS score (standard deviation) during DTaP-IPV-Hib injection was lower in the fast injection group: 6.4 (2.7) vs. 7.4 (2.5), respectively; p=0.046. Regression analysis demonstrated a positive correlation between injection speed and pain. There were no other differences between groups. CONCLUSION:Fast injection reduced injection-induced pain in infants receiving DTaP-IPV-Hib but not PCV vaccine. Fast injections are recommended when administering vaccines because of the potential for a reduction in pain, feasibility and practicality. TRIAL REGISTRATION: NCT02504398.
RCT Entities:
OBJECTIVE: This study compared the pain caused from fast vs. slow vaccine injections. METHODS:Infants aged 2-6months receiving primary immunizations were randomized to fast (2-4mL/s) or slow (5-10mL/s) injections during routine 0.5mL Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) injections. Those aged 2 and 4months additionally received 0.5mL Pneumococcal Conjugate Vaccine (PCV) injections. A research assistant and parent unaware of treatment allocation and hypothesis assessed pain using validated and recommended tools, including; the Modified Behavioural Pain Scale (MBPS, range 0-10), cry duration, and Numerical Rating Scale (NRS, range 0-10). The primary outcome was infantpain score using the MBPS. RESULTS: Altogether, 120 were recruited; 61 were randomized to fast injections and 59 to slow injections. One hundred and ninteen infants participated. There were no differences in characteristics, including; age (p=0.994) and sex (p=0.540). The mean MPBS score (standard deviation) during DTaP-IPV-Hib injection was lower in the fast injection group: 6.4 (2.7) vs. 7.4 (2.5), respectively; p=0.046. Regression analysis demonstrated a positive correlation between injection speed and pain. There were no other differences between groups. CONCLUSION: Fast injection reduced injection-induced pain in infants receiving DTaP-IPV-Hib but not PCV vaccine. Fast injections are recommended when administering vaccines because of the potential for a reduction in pain, feasibility and practicality. TRIAL REGISTRATION: NCT02504398.
Authors: Nicole C O'Connell; Hilary A Woodward; Pamela L Flores-Sanchez; Son H McLaren; Maria Ieni; Kenneth W McKinley; Sripriya T Shen; Peter S Dayan; Daniel S Tsze Journal: J Am Coll Emerg Physicians Open Date: 2020-08-26