OBJECTIVE Anxiety and pain during medical procedures may have adverse short and long-term consequences. We summarize the effectiveness of hospital clown interventions, as compared with medication, the presence of a parent, standard care, and other non-pharmacological distraction interventions on anxiety and pain in minors undergoing medical procedures. METHOD Randomized trials were identified in PsycINFO, MEDLINE, Embase, Scopus and CINAHL, and previous reviews. Screening of titles and abstracts and full-texts, data extraction and risk of bias assessment was done by two independent reviewers. We conducted random-effects network and pairwise meta-analyses based on a frequentist framework. RESULTS Our analyses with 28 studies showed significantly lower anxiety scores in clowning and other distraction interventions as compared with the presence of parents. No differences were observed between clowning, medication, and other distraction interventions. Clowning interventions were superior to standard care in our main analyses, but non-significant in some of the sensitivity analyses. Furthermore, clowning led to significantly lower pain as compared with presence of parents and standard care. No differences were observed between clowning interventions and the other comparators. For both outcomes, large between study heterogeneity was present but no significant inconsistency between designs. Risk of bias was mainly high and accordingly the certainty of evidence is considered moderate to low. CONCLUSIONS We found no significant difference between medication, other non-medical distraction interventions and hospital clown interventions. Hospital clowns and other distraction interventions were more effective in reducing anxiety and pain in children undergoing medical procedures than the presence of parents alone. In order to allow for better insights regarding the comparative effectiveness of clowning interventions future trials should include detailed descriptions about the clowning intervention itself and the comparator. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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医院小丑对儿科焦虑和疼痛的有效性：网络荟萃分析。

目标 医疗过程中的焦虑和疼痛可能会产生不利的短期和长期后果。我们总结了医院小丑干预的有效性，与药物、父母在场、标准护理和其他非药物分心干预相比，对接受医疗程序的未成年人的焦虑和疼痛进行了比较。方法 在 PsycINFO、MEDLINE、Embase、Scopus 和 CINAHL 以及之前的评论中确定了随机试验。标题、摘要和全文的筛选、数据提取和偏倚风险评估由两名独立评审员完成。我们基于常客框架进行了随机效应网络和成对元分析。结果 我们对 28 项研究的分析表明，与父母在场相比，小丑表演和其他分散注意力的干预措施的焦虑得分显着降低。在小丑表演、药物治疗和其他分散注意力的干预措施之间没有观察到差异。在我们的主要分析中，小丑干预优于标准治疗，但在某些敏感性分析中不显着。此外，与父母在场和标准护理相比，小丑表演导致疼痛明显减轻。小丑干预和其他比较者之间没有观察到差异。对于这两种结果，存在较大的研究异质性，但设计之间没有显着不一致。偏倚风险主要是高，因此证据的确定性被认为是中等到低。结论 我们发现药物、其他非医疗分心干预和医院小丑干预之间没有显着差异。与父母单独在场相比，医院小丑和其他分散注意力的干预措施在减少接受医疗程序的儿童的焦虑和疼痛方面更有效。为了更好地了解小丑干预的比较有效性，未来的试验应该包括对小丑干预本身和比较对象的详细描述。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。与父母单独在场相比，医院小丑和其他分散注意力的干预措施在减少接受医疗程序的儿童的焦虑和疼痛方面更有效。为了更好地了解小丑干预的比较有效性，未来的试验应该包括对小丑干预本身和比较对象的详细描述。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。与父母单独在场相比，医院小丑和其他分散注意力的干预措施在减少接受医疗程序的儿童的焦虑和疼痛方面更有效。为了更好地了解小丑干预的比较有效性，未来的试验应该包括对小丑干预本身和比较对象的详细描述。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。