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Certified Child Life Specialists Lessen Emotional Distress of Children Undergoing Laceration Repair in the Emergency Department

Hall, Johanna E., MD, FAAP*; Patel, Dhruv P., BS; Thomas, John W., MD; Richards, Catherine A., BSN, RN; Rogers, Philip E., ADN, RN; Pruitt, Christopher M., MD, FAAP§

doi: 10.1097/PEC.0000000000001559
Original Articles

Objective The objective of this study is to evaluate the impact of certified child life specialists (CCLSs) on the emotional responses of children undergoing laceration repair in the emergency department (ED).

Methods Patients 4 to 12 years of age who required laceration repair by suturing were prospectively enrolled at an urban tertiary pediatric ED. Certified child life specialists are not available at all times in our institution, allowing for a priori categorization of subjects into 2 comparison groups, those with and those without CCLS involvement. Subjects requiring anxiolysis, pharmacologic sedation, narcotics, or physical restraint were excluded. The Children's Emotional Manifestation Scale, a previously validated Likert-like tool, was used to quantify the patients' distress, with a higher score reflecting a more emotional child. Just before placement of the first suture, subjects were scored by trained independent observers. Baseline data included age, sex, race, type of local anesthetic, length and location of laceration, and analgesics administered. The primary endpoint of emotional score was compared with a 2-tailed Mann-Whitney U test, with a P < 0.05 considered statistically significant.

Results Two hundred one patients constituted the final study cohort, with 103 (51%) having CCLS involvement. Study groups did not differ in regards to any baseline demographic or clinical characteristics. The median emotional score for patients with child life services was 7 (interquartile range, 6–9) versus 9 (interquartile range, 7.5–12) for those without (P < 0.0005).

Conclusions Certified child life specialist involvement is associated with less emotional distress for children undergoing laceration repair in the ED.

From the *Memorial Health University Medical Center, Savannah, GA;

University of Alabama at Birmingham School of Medicine;

Children's of Alabama; and

§Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.

Disclosure: The authors declare no conflict of interest.

Reprints: Christopher M. Pruitt, MD, FAAP, Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, 1600 5th Ave S, CPP1, Suite 110, Birmingham, AL 35233 (e-mail:

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