Crevatin 2016.

Study characteristics
Methods	RCT. 2 arms.
Participants	Number of children: 100 control, 100 treatment Sex of children: 98 M, 102 F Age range of children: 4 ‐ 13 years Mean age range of children: 8.6 years (treatment); 8.9 years (control) Needle procedure: venipuncture Diagnosis of child: 12% (treatment) and 19% (control) with mixed chronic disease Inclusion criteria: 4 ‐ 13 years, at blood drawing center to have blood sample collected by venipuncture Exclusion criteria: patient history of epilepsy, use of topical, enteral or parenteral analgesics up to 8 hours before blood drawing, inability to have venipuncture performed on their hand or arm, presence of cognitive impairment or inability to report pain verbally Setting: blood‐drawing center of tertiary‐level children’s hospital in Italy
Interventions	1. Hand‐held computer distraction: Children played Angry Birds, a game in which they had to shoot birds into the pig’s fortresses, on a hand‐held computer. Children started to play the game 3 minutes before the procedure and then continued for a maximum of 3 minutes after the procedure. 2. Nurse‐led low‐tech distraction (‘Standard care’): Children received various kinds of conventional distractions from a nurse (nurse singing a song, reading a book, blowing bubbles, performing a puppet show) starting 3 minutes before the procedure. The technique that most engaged the child was continued during the procedure.
Outcomes	Pain measures: Child self‐report (4 ‐ 7 year‐olds): FPS‐R Child self‐report (8 ‐ 13 year‐olds): Numerical rating scale (0 ‐ 10) Adverse events: none mentioned
Notes	Study dates: March to June 2013 Funding: none stated Conflicts of interest: none declared
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "generated using a computer‐based method" p.931
Allocation concealment (selection bias)	Low risk	Quote: "guaranteed using sealed consecutively numbered opaque envelopes" p.931
Blinding of participants and personnel (performance bias) All outcomes	High risk	Study participants and personnel were not blinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding of outcome assessment
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing data
Selective reporting (reporting bias)	Low risk	Primary and secondary outcomes clearly stated and reported
Other bias	Low risk	Appears to be free of other bias that would affect outcomes