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Blood pressure is measured in the triage among most children presenting to the Pediatric ED. There are many barriers to obtaining an accurate BP measurement in children, including inappropriate technique, lack of equipment, but also – pain, and the child’s uncooperativeness or anxiety. The later may even be accentuated in the ED setting. These factors may lead to falsely elevated BP reading, which may provoke significant anxiety in children and families and possibly lead to a cascade of unnecessary investigation and consultations. Additionally, an abnormal measured BP value routinely mandate an additional measurement attempt which itself may cause anxiety and restlessness among children, especially toddlers and infants and prolongs the entire triage process. *Correspondence to: Omer Raviv, Meir Medical Center, Kfar Saba, Israel, Tel: 972528822052, E-mail: omerol@walla.co.il Received: May 15, 2018; Accepted: June 15, 2018; Published: June 19, 2018 The Second Task Force Report on Blood Pressure Control in Children does emphasize blood pressure measurement in a quiet environment, using a proper size cuff, and using appropriate technique [1]. Ideally, BP should be measured in a quiet setting in a relaxed child, with several measurements taken at each. This scenario is nearly impossible in the emergency department, as demonstrated in a previous retrospective study that indicated that although BP was elevated in 52% of children who underwent triage blood pressure measurement in the ED, the measurement was repeated in the in only 38% [2]. In the past decade, there has been a rapid growth in the presence of therapeutic clowns in hospitals, particularly in pediatric settings [3]. a recent study conducted in a PED in Israel has demonstrated the benefit of medical clowns in diminishing pain and anxiety during painful procedures being performed on children in the ED [4]. Previous studies conducted in our institute have demonstrated a beneficial effect on vital signs [blood pressure and heart rate] as a sign of decreased anxiety following the incorporation of a medical clown in a multisystem team caring for pediatric patient [5,6]. Blood pressure measurement among pediatric patients, although is not a painful procedure, may cause a stressful reaction, prolonging the entire process and requiring additional attempts – making it a time consuming task in a busy ED. A beneficial effect of a medical clown on the pediatric patient by decreasing the stress reaction and may shorten the entire process, and, in terns, making it much more efficient. We are unaware of any studies conducted related to the effect of the use of medical clowns during ED blood pressure measurements in the triage. AIMS: we speculate that the incorporation of a medical clone during the procedure of blood pressure measurement in the triage will shorten the procedure and decrease the number of attempts, making it much more efficient.

The effect of medical clowns on blood pressure measurement in children presenting to the emergency department