Evidence map›Paper›PMID 26352919›Full record

SynthesisThe Clinical journal of pain2015

Procedural and Physical Interventions for Vaccine Injections: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials.

Anna Taddio, Vibhuti Shah, C Meghan McMurtry, Noni E MacDonald, Moshe Ipp, Rebecca Pillai Riddell, Melanie Noel, Christine T Chambers, HELPinKids&Adults Team

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Clinical journal of pain, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 10 pooled it
6.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 10 syntheses or guidelines pooled it, 78 citations in OpenAlex.

  1. Reducing distress during vaccine injections: 2026 clinical practice guideline update.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
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  10. Reducing pain during vaccine injections: clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 2 countries.

Anna Taddio*Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy §Faculty of Medicine, University of Toronto †Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario ††Department of Paediatrics, The Hospital for Sick Children ‡Department of Pediatrics, Mount Sinai Hospital ‡‡Department of Psychology, York University, Toronto ∥Department of Psychology, University of Guelph, Guelph, Ontario ¶Children's Health Research Institute #Department of Paediatrics, Western University, London, ON **Department of Paediatrics, IWK Health Centre, Dalhousie University and Canadian Center for Vaccinology ∥∥Department of Pediatrics and Psychology, Faculty of Science, Dalhousie University, IWK Health Centre, Halifax, NS, Canada §§Department of Psychology, University of Calgary, AB, Canada.
Vibhuti Shah
C Meghan McMurtry
Noni E MacDonald
Moshe Ipp
Rebecca Pillai Riddell
Melanie Noel
Christine T Chambers
HELPinKids&Adults Team
University of Toronto · CAUniversity of Guelph · CA3M (United States) · USHospital for Sick Children · CASickKids Foundation · CA

Funding

Canadian Institutes of Health Research KRS 132031
6 · The paper itself

Abstract

backgroundThis systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination. DESIGN/

methodsDatabases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods.

resultsA total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected indices of fainting in adolescents and adults.

conclusionsInterventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.

Indexed as

PainPain ManagementPhysical Therapy ModalitiesRandomized Controlled Trials as TopicVaccinationHumansPhysical Examination

Identifiers

PMID26352919
PMCPMC4900423
OpenAlexW2417046749

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.