Abstract
Background: Assessment of the endothelial function of the microvasculature by peripheral arterial tonometry (PAT) has gained increasing popularity in pediatrics. Discomfort or experienced pain during fingertip PAT has only been studied in adolescents and adults.Methods: In 142 children (aged 4–11 years old), a fingertip PAT with a commercial device (EndoPAT 2000®) as well as a caliper and ultrasound examination of peripheral skinfolds were performed as part of a cross-sectional cohort study. In 110 children, Faces Pain Scale (FPS-R) data were collected after PAT and skinfold measurements by caliper and ultrasound.Results: In 111 out of the 142 PAT measurements (78.2%), a reactive hyperemia index (RHI) could be obtained. The most frequent error messages by the software was a “too noisy” and/or a “poor quality” signal. The success rate was higher in children aged older than 6 years (83.1 vs. 44.4%; p < 0.001). Median (range) FPS-R after PAT was 0 (range 0–6) but was significantly higher than the median pain experienced after caliper measurements of peripheral skinfolds (p < 0.001). No pain was experienced by 59 of the 110 children (54.1%).Conclusion: PAT testing is feasible in the great majority of school-aged children, and the procedure is well-tolerated.
Highlights
Peripheral arterial tonometry (PAT) measurement enables researchers and clinicians to assess endothelial function in a non-invasive manner, in arteriosclerosis risk populations, such as familial hypercholesterolemia, type 1 diabetes, and severe obesity [1,2,3,4,5,6,7,8,9]
PAT Feasibility in Children (RHI), is measured with a thimble-shaped finger cap that imparts a systematic pressure at the distal phalanx of the index fingers [10,11,12]
The first main challenge is to provide adequate and child age-appropriate reassurance before starting the test. This is to try to diminish the fear of the finger clamping and the eventual pain of discomfort experienced by the upper arm compression, as anger and anxiety are associated with lower reactive hyperemia index (RHI) [14]
Summary
Peripheral arterial tonometry (PAT) measurement enables researchers and clinicians to assess endothelial function in a non-invasive manner, in arteriosclerosis risk populations, such as familial hypercholesterolemia, type 1 diabetes, and severe obesity [1,2,3,4,5,6,7,8,9]. The first main challenge is to provide adequate and child age-appropriate reassurance before starting the test. This is to try to diminish the fear of the finger clamping and the eventual pain of discomfort experienced by the upper arm compression, as anger and anxiety are associated with lower RHI [14]. While pain has been reported by a small percentage, and the discomfort associated with the arterial occlusion was rather described as “a tingling feeling” or “nearly painless” by either adolescent or adult patients, the tolerance of PAT testing in school-aged children has not been reported [13, 15]. Discomfort or experienced pain during fingertip PAT has only been studied in adolescents and adults
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