The Use of an Audio-Visual Method in Counseling for Pediatric Lumbar Puncture Procedure, a Randomized Controlled Trial in Pediatric Emergency Settings.

Background: Lumbar puncture (LP) is a relatively safe and routinely performed procedure in pediatrics, although it can still provoke parental anxiety and refusal. Audiovisual (AV) explanatory aids may enhance counseling and support shared decision-making. However, their role in pediatric procedures is limited, and no published studies have evaluated the use of an adjunct educational video for LP counseling in a pediatric emergency setting. Method: We conducted a single center randomized controlled trial in the pediatric emergency department (ED). Parents were randomized to receive either standard verbal counseling for LP or counseling supplemented with an educational video. The primary outcome was parental acceptance of LP. Secondary outcomes included parental self-rated understanding, perception of the procedure safety and painfulness, and overall comfort. We also explored reasons for LP refusal in our community and obtained clinicians’ perspectives on using the AV aid. Results: A total of 101 parents were enrolled and randomized (52 to the AV group, 49 to the control group). Parental acceptance of LP was significantly higher in the AV group compared with standard counseling (90% vs. 73%, p=0.026). Parents in the AV group reported greater understanding (p<0.001), higher perception of safety (p=0.037), and more comfort (p=0.03). “Fear of complications” was the most reported reason for LP refusal, with “paralysis” being the commonest fear. Clinicians provided positive feedback on using the AV aid, indicating that it was adaptable to ED workflow. Conclusion: Use of an AV explanatory aid during counseling for pediatric LP is associated with a higher acceptance rate, greater parental comprehension, and comfort. These tools are useful and recommended to be standardized as complementary to verbal counseling for common pediatric procedures.