Gold 2006.

Study characteristics
Methods	RCT. 2 arms.
Participants	Number of children: 10 control, 10 treatment Sex of children: 12 M, 8 F Age range of children: 8 ‐ 12 years Mean age of children: 10.2 years Needle procedure: IV Diagnosis of child: heterogeneous, 12/20 had “medical conditions” Inclusion criteria: awaiting MRI or CT scans, required IV placement Exclusion criteria: children with known or reported cognitive disabilities, taking pain medication, did not pass the cognitive and physical screening Setting: Department of Radiology at Childrens Hospital Los Angeles, United States
Interventions	1. Virtual reality distraction: Standard care and VR game presented through a head‐mounted display, which began 5 minutes before IV placement and continued for 5 minutes afterwards 2. Standard care control: Topical anesthesia spray prior to IV placement
Outcomes	Pain measure: Child‐self report: FPS‐R, Wong Baker FACES Pain Rating Scale, VAS (IV pain intensity) Adverse events: none mentioned
Notes	Study dates: study dates not reported Funding: donation Conflicts of interest: none declared
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Stratified according to age (7‐9, 10‐12), then randomized to condition ‐ no further details. Insufficient information to permit judgment of 'low' or 'high' risk
Allocation concealment (selection bias)	Unclear risk	Insufficient information to permit judgment of 'low' or 'high' risk
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel were not blinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding of self‐report outcome assessment
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing data
Selective reporting (reporting bias)	High risk	One or more outcomes of interest are reported incompletely (i.e. nurse and parent report)
Other bias	High risk	Small sample size potential source of bias affecting outcomes