Bedside Evaluation Research Articles

Relationship between Pulsatility Index and Volume Status in Patients with Left Ventricular Assist Devices

Introduction Volume overload continues to be a common complication after left ventricular assist device (LVAD) implantation due to years of heart failure complicated with pulmonary hypertension, right ventricle dysfunction and poor nutritional status. In fact, fluctuation in volume status is one of the most dynamic parameters in patients with LVADs and becomes one of the key components of the routine clinical evaluation in these patients. We hypothesize that postural changes in the pulsatility index (PI) may be an accurate non-invasive measure of volume status that can potentially be easily used in clinic or by patients at home to adjust their fluid intake and diuretics. Methods We included patients at least 1 month post-LVAD implantation being followed in the Advance Heart Failure Clinic at Scripps Clinic. We excluded patients unable to stand for at least 10 minutes or too unstable to cooperate. We measured systolic (SBP), diastolic and mean (MAP) blood pressure, heart rate and LVAD parameters including PI supine and after 2 minutes of standing. Supine and standing inferior vena cava (IVC) assessment was performed by bedside echocardiography. All measurements were obtained within 1 hour with no interval intervention. Results We included 20 patients status post continuous flow LVAD. Mean time from implant was 947.5 days (range 55 - 2533 days). We were able to obtain both supine and standing echocardiograms for IVC assessment in 14 (70%) patients. We found a positive and significant correlation between postural changes in PI and postural changes in IVC (R= 0.61, p = 0.02). There were no significant changes in supine and standing SBP and MAP (SBP: 101 ± 10 and 100 ± 10 mmHg, p=0.59; MAP: 82 ± 6 and 85 ± 7 mmHg, p=0.13). We did not find a statistically significant correlation between postural changes in PI and postural changes in MAP (r = 0.15, p = 0.55). Five patients (25%) had positive orthostatic vital signs and 14 (70%) had documented PI events the days prior to the study inclusion. There was a trend for larger postural PI changes in patients with positive orthostatic vital signs or PI events, although this did not reach statistical significance (p = 0.88 and p = 0.79, respectively). Conclusion Changes in LVAD PI seem to correlate with volume status rather than systemic blood pressure. There is a trend for larger postural PI changes in orthostatic patients and those with documented PI events. Postural PI change assessment could aid in the immediate bedside evaluation of volume status in LVAD patients. Furthermore, PI changes could be documented by patients remotely and used by providers for interval treatments without presentation to clinic.

4-D Intracardiac Ultrasound Vector Flow Imaging-Feasibility and Comparison to Phase-Contrast MRI.

In vivo characterization of intracardiac blood velocity vector fields may provide new clinical information but is currently not available for bedside evaluation. In this paper, 4-D vector flow imaging for intracardiac flow assessment is demonstrated using a clinical ultrasound (US) system and a matrix array transducer, without the use of contrast agent. Two acquisition schemes were developed, one for full volumetric coverage of the left ventricle (LA) at 50 vps and a 3-D thick-slice setup with continuous frame acquisition (4000 vps), both utilizing ECG-gating. The 3-D vector velocity estimates were obtained using a novel method combining phase and envelope information. In vitro validation in a rotating tissue-mimicking phantom revealed velocity estimates in compliance with the ground truth, with a linear regression slope of 0.80, 0.77, and 1.03 for the , , and velocity components, and with standard deviations of 2.53, 3.19, and 0.95 cm/s, respectively. In vivo measurements in a healthy LV showed good agreement with PC-MRI. Quantitative analysis of energy loss (EL) and kinetic energy (KE) further showed similar trends, with peak KE at 1.5 and 2.4 mJ during systole and 3.6 and 3.1 mJ for diastole for US and PC-MRI. Similar for EL, 0.15- 0.2 and 0.7 mW was found during systole and 0.6 and 0.7 mW during diastole, for US and PC-MRI, respectively. Overall, a potential for US as a future modality for 4D cardiac vector flow imaging was demonstrated, which will be further evaluated in clinical studies.

New insights in the use of pleural ultrasonography for diagnosis and treatment of pleural disease.

The use of transthoracic ultrasound (US) has acquired a wide consensus among respiratory physicians during the last few years. The development of portable devices promotes patient's bedside evaluation providing rapid, real-time and low-cost diagnostic information. The different acoustic impedance between different tissues and organs produces artifacts known as A lines, B lines, sliding sign, lung point, etc. The identification of such artifacts is essential to discriminate normal pleural appearance from the presence of pleural effusion, pneumothorax, thickenings and tumors. Ultrasounds are also a valuable tool during interventional procedures, such as thoracentesis, chest tube insertion and transcutaneous biopsy. Its use is recommended before medical thoracoscopy in order to assess the best site of trocar insertion according to presence, quantity and characteristics of pleural effusion. The aim of this review is to provide practical tips on chest ultrasound in clinical and interventional respiratory practice.

Acute Unilateral Audiovestibulopathy due to Embolic Labyrinthine Infarction.

Labyrinthine infarction is a cause of acute audiovestibulopathy, but can be diagnosed only in association with other infarctions involving the brainstem or cerebellar areas supplied by the anterior inferior cerebellar artery (AICA) since current imaging techniques cannot visualize an infarction confined to the labyrinth. This case series aimed to establish embolic labyrinthine infarction as a mechanism of isolated acute audiovestibulopathy. We analyzed clinical features, imaging findings, and mechanisms of embolism in 10 patients (8 men, age range: 38-76) who had developed acute audiovestibulopathy in association with an obvious source of embolism and concurrent acute embolic infarctions in the non-anterior inferior cerebellar artery territories. The presence of audiovestibulopathy was defined when bedside or laboratory evaluation documented unilateral vestibular (head-impulse tests or caloric tests) or auditory loss (audiometry). Six patients showed combined audiovestibulopathy while three had isolated vestibulopathy. One patient presented isolated hearing loss. Audiovestibular findings were the only abnormalities observed in nine patients. In all patients, MRIs documented single or multiple infarctions in the cerebellum (n = 5) or cerebral hemispheres (n = 5). Especially three patients showed single or scattered foci of tiny acute infarctions only in the cerebral hemispheres. Cardiac sources of embolism were found in eight, and artery-to-artery embolism was presumed in two patients. Selective embolism to the labyrinth may be considered in patients with acute unilateral audiovestibulopathy and concurrent acute infarctions in the non-AICA territories.

Adductor Pollicis Muscle Thickness and Obesity Are Associated with Poor Outcome after Stroke: A Cohort Study

Nutritional status may influence outcome after stroke. It is possible that some obese individuals present reduced fat-free mass. We aimed to determine if bedside evaluation of body composition by the body mass index (BMI), adductor pollicis muscle thickness (APMT) and arm muscle area (AMA), and the combination of low APMT or AMA with obesity are associated with disability 90 days after stroke. A cohort study evaluating 120 patients hospitalized at the Stroke Unit was carried out. Data were expressed as average ± standard deviation or median and percentiles. Obesity was evaluated by BMI and fat-free mass by the APMT and AMA. Receiver operating characteristic (ROC) curves and multivariate logistic regression analysis were used to measure whether APMT and obesity were associated with modified Rankin Scale (mRS) ≥3 (disability) within 90 days of stroke. The data were adjusted for National Institutes of Health Stroke Scale (NIHSS), sex, age, type of stroke, and thrombolysis. The significance level was 5%. Of 120 patients, we came up with the following demographics: men: 66 (55.0%); mean age: 66.6 ± 13.2 years; ischemic stroke: 109 (90.8%); mean NIHSS: 4 (2-10); thrombolysis: 18 (16.5%). Considering mRS ≥3, ROC curve analysis showed that the value of the cutoff for APMT was <12.5 mm. In multivariate analysis adjusted for the above factors, each 1 mm of increase in APTM reduced the chance of disability by 31%. The intersection of obesity with APMT <12.5 mm increased by 37-fold the risk of disability. AMA was not associated with mRS ≥3. Lower APMT alone or in combination with obesity was associated with poor functional status.

Ultrasound for Volume Assessment in Patients with Shock: Effectiveness of an Educational Intervention for Fourth-year Medical Students.

ObjectiveShock is a common emergency condition with high morbidity and mortality, and judicious fluid resuscitation can significantly affect outcomes. The use of a bedside echocardiogram and evaluation of the inferior vena cava (IVC) via ultrasound (US) for collapsibility can predict volume status. Additionally, the Association of American Medical Colleges (AAMC) Entrustable Professional Activities (EPA) 10 states that residents need to be able to address a patient with a critical illness, including hypotension, on Day 1 of residency. Existing literature revealed no published curriculum to teach medical students these skills. We aimed to determine the effectiveness of an educational intervention to teach fourth-year medical students how to utilize IVC US measurement and echocardiography to assist in volume assessment of patients presenting with shock.MethodsStudents participated in an hour session on the first day of the emergency medicine (EM) clerkship. Didactic effectiveness was evaluated by comparing results on a pre-test and post-test. The test was administered to residents and attendings during the first week of the academic year to gain evidence for content validity. Students also responded to a survey to evaluate learner satisfaction.ResultsThe average score on the validation test was 68.4% (standard deviation (SD): 21.6%, number (n) = 38) for residents and attendings, and 47.4% (SD: 19.4, n = 13) for interns. Students scored an average of 45.6% (SD: 23.6, n = 83) on the pre-test and 66.4% (SD: 22.1 n = 72) on the post-test, p < 0.01 (degrees of freedom (df) = 153, t = 5.7), Cohen's d = 0.92. The satisfaction survey showed 97.6% of students felt the session was worthwhile, 96.4% would recommend it to other students, and 83.1% felt it taught new information.ConclusionThese results show that the educational intervention provides a significant increase in knowledge regarding volume assessment and the use of echocardiogram and IVC US. Additionally, students rated the course highly and felt that it provided information not otherwise taught in medical school. This curriculum addresses the AAMC EPA 10, as it increases students’ readiness to address hypotension and could add significant value to the medical school curriculum.

Non-invasive hemodynamic evaluation by Doppler echocardiography.

The approach for treating a hemodynamically unstable patient remains a diagnostic and therapeutic challenge. Stabilization of the patient should be rapid and effective, but there is not much room for error. This narrow window of intervention makes it necessary to use rapid and accurate hemodynamic evaluation methods. Echocardiography is the method of choice for the bedside evaluation of patients in circulatory shock. In fact, it was intensive care physicians who recognized the potential of Doppler echocardiography for the initial approach to patients in circulatory failure. An echocardiogram allows rapid anatomical and functional cardiac evaluation, which may include non-invasive hemodynamic evaluation using a Doppler study. Such an integrated study may provide data of extreme importance for understanding the mechanisms underlying the hemodynamic instability of the patient to allow the rapid institution of appropriate therapeutic measures. In the present article, we describe the most relevant echocardiographic findings using a practical approach for critical patients with hemodynamic instability.

Urology residents on call: Investigating the workload and relevance of calls.

On-call medical services assumed by residents represent many hours of hard work and no studies have documented what it really entails. As part of an effort to improve our on-call system, we examined phone calls received by residents on call. Our objectives were to evaluate the characteristics of phone calls received by residents on call (who, when, why, need to go to the hospital) and to determine residents' perception of these calls. We also looked into implementing strategies to reduce unnecessary calls. We prospectively collected information about calls using a standardized reporting form with the participation of all residents (10) from a single urology program over two periods of four weeks from November 2014 to March 2015. Residents answered pre- and post-collecting period questionnaires. A total of 460 calls were recorded on 97 on-call days in two on-call lists. There was a mean of 3.5 (median 3, range 0-12) calls per weeknight and 7.7 (median 6, range 0-23) calls per weekend full day. Nintey-three calls (20%) led to the need for bedside evaluation and many of these were for new consultations (49%). The majority of calls originated from the clinical in-patient ward (49%) and emergency room (29%), and nurses (66%) and doctors (23%) most commonly initiated the calls. Calls between 11:00 pm and 8:00 am represented 13% of all calls. Most of the calls (77%) were perceived as relevant or very relevant. Most residents reported at least 80% of calls. Although likely representing an underestimate of the reality, we provide a first effort in documenting the call burden of Canadian urology residents.

Basics of Functional Echocardiography in Children and Neonates.

Functional echocardiography has become an invaluable tool in the pediatric and neonatal intensive care unit. “Point-of-care,” “target,” or “focus” echocardiography allows bedside cardiac ultrasound evaluation of the hemodynamic status of the patient, helps in directing treatment, thus improves patients care. In order to be able to perform functional echocardiography, it is essential to understand the principles of ultrasound, to know the echocardiographic equipment and settings necessary to acquire the images. This article focuses therefore on the basics of cardiac ultrasound. It is meant to give an overview of two-dimensional echocardiographic views, M-mode imaging and Doppler echocardiography for neonatologists and pediatric intensivists. It is richly illustrated for better understanding with some examples of clinical applications of functional echocardiography in the intensive care setting.

5 A study analysing the diagnostic performance of ECG interpretation for 30-day major cardiac events in the emergency department

Study objectiveThis study evaluates the diagnostic accuracy of an Emergency Medicine (EM) clinician at identifying ischaemia on an ECG using 30-day major adverse cardiac events (MACE) as the primary outcome.MethodsThis...

Cerebral and Limb Tissue Oxygenation During Peripheral Venoarterial Extracorporeal Life Support.

Femoral access in extracorporeal life support (ECLS) has been associated with regional variations in arterial oxygen saturation, potentially predisposing the patient to ischemic tissue damage. Current monitoring techniques, however, are limited to intermittent bedside evaluation of capillary refill among other factors. The aim of this study was to assess whether cerebral and limb regional tissue oxygen saturation (rSO2) values reflect changes in various patient-related parameters during venoarterial ECLS (VA-ECLS). This retrospective observational study included adults assisted by femorofemoral VA-ECLS. Bifrontal cerebral and bilateral limb tissue oximetry was performed for the entire duration of support. Hemodynamic data were analyzed parallel to cerebral and limb rSO2. A total of 23 patients were included with a median ECLS duration of 5 [1-20] days. Cardiac arrhythmias were observed in 12 patients, which was associated with a decreased mean rSO2 from 61%±11% to 51%±10% during atrial fibrillation and 67%±9% to 58%±10% during ventricular fibrillation (P<0.001 for both). A presumably sudden increase in cardiac output due to myocardial recovery (n=8) resulted in a significant decrease in mean cerebral rSO2 from 73%±7% to 54%±6% and from 69%±9% to 53%±8% for the left and right cerebral hemisphere, respectively (P=0.012 for both hemispheres). Also, right radial artery partial gas pressure for oxygen decreased from 15.6±2.8 to 8.3±1.9 kPa (P=0.028). No differences were found in cerebral desaturation episodes between patients with and without neurologic complications. In six patients, limb rSO2 increased from on average 29.3±2.7 to 64.0±5.1 following insertion of a distal cannula in the femoral artery (P=0.027). Likewise, restoration of flow in a clotted distal cannula inserted in the femoral artery was necessary in four cases and resulted in increased limb rSO2 from 31.3±0.8 to 79.5±9.0; P=0.068. Non-invasive tissue oximetry adequately reflects events influencing cerebral and limb perfusion and can aid in monitoring tissue perfusion in patients assisted by ECLS.

A Case of Metronidazole Injection Infiltration Without Sequelae.

Purpose: This report describes a case of metronidazole injection infiltration which contrasts the sole other case report in the literature at this time, as the patient described herein experienced mild signs and symptoms with prompt resolution and no significant sequelae. Summary: The patient experienced metronidazole injection infiltration during administration open to gravity via an 18-gauge peripheral catheter in the left brachial vein. The site was examined at bedside within approximately 30 minutes of the incident and was noted to be slightly edematous, erythemic, and painful in terms of a 5.5 × 6.6-cm area. No blanching, blister formation, induration, skin discoloration, or diminished capillary refill were observed. The event was conservatively managed in the form of catheter discontinuation and marking of the affected area with a patient skin marker, as hyaluronidase was not administered due to a product osmolarity of ~314 mOsM/L and pH of 5.8. A bedside evaluation the next morning revealed full resolution of the previously described symptoms. The patient was discharged from the facility 11 days later without further complications from the infiltration event. Conclusion: We describe a case of metronidazole injection infiltration which did not require pharmacologic or nonpharmacologic interventions and resulted in complete resolution. This case supplements the current literature by contrasting the sole other case report which resulted in profound necrosis near the intravenous access site. This case suggests metronidazole infiltrations may not require clinician alarm or treatment if events occur under circumstances similar to that which is presented.

P1124Rapid acute myocardial infarction rule-out using the limit of detection of a point of care troponin assay: early results of the Bedside Evaluation of Sensitive Troponin (BEST) study

P1124Rapid acute myocardial infarction rule-out using the limit of detection of a point of care troponin assay: early results of the Bedside Evaluation of Sensitive Troponin (BEST) study

Novel Contrast‐Enhanced Ultrasound Evaluation in Neonatal Hypoxic Ischemic Injury: Clinical Application and Future Directions

Sensitive, specific, and safe bedside evaluation of brain perfusion is key to the early diagnosis, treatment, and improved survival of neonates with hypoxic ischemic injury. Contrast-enhanced ultrasound (US) imaging is a novel imaging technique in which intravenously injected gas-filled microbubbles generate enhanced US echoes from an acoustic impedance mismatch. This article describes contrast-enhanced US imaging in 2 neonates with hypoxic ischemic injury and future directions on developing quantitative contrast-enhanced US techniques for improved characterization of perfusion abnormalities. The importance of studying the temporal evolution of brain perfusion in neonatal hypoxic ischemic injury is also highlighted.

Implementation of a Maternal Early Warning System in an Academic Medical Center

The Maternal Early Warning System (MEWS) includes abnormal parameters that act as triggers. The goal is early recognition of signs of deterioration. Early signs of decline are often subtle and challenging to identify since physiologic compensatory mechanisms can mask signs. This system expedites recognition and action for worsening maternal condition. The following criteria are used: systolic blood pressure less than 90 mm Hg or greater than 160 mm Hg, diastolic blood pressure greater than 100 mm Hg, heart rate less than 50 beats per minute or greater than 120 beats per minute, respiratory rate less than 10 breaths per minute or more than 30 breaths per minute, oxygen saturation less than 95%, oliguria 35 mL or more per hour for 2 hours, confusion. When a trigger is identified, a nurse initiates supportive interventions and a health care provider is notified and performs timely bedside evaluation and necessary diagnostic and therapeutic interventions. Surveillance is maintained until resolution or transfer to higher level of care occurs. Nurses are empowered to activate the rapid response team at their discretion. Education includes who to notify, nursing interventions, and the chain of command as indicated. A pocket card with triggers was distributed to staff. After the implementation, the average time of arrival of the health care provider decreased from 60 minutes to 8 minutes. Most events were for elevated blood pressure. Activations of the rapid response team increased from three events in 2012 and 2013 to five in 2104 and 2015. Standardization of early warning triggers decreases variation and increases patient care reliability. Timely evaluation led to a decrease in maternal morbidity. Outcomes include nurse descriptions of a heightened safety culture.

Postoperative Swallowing Assessment After Lung Transplantation

Dysphagia, aspiration, and potential pneumonia represent a major source of morbidity in patients undergoing lung transplantation. Conditions that potentiate dysphagia and aspiration include frailty and prolonged intubation. Our group of speech-language pathologists has been actively involved in performance of a bedside evaluation of swallowing, and instrumental evaluation of swallowing with modified barium swallow, and postoperative management in patients undergoing lung transplantation. All lung transplant patients from April 2009 to September 2012 were evaluated retrospectively. A clinical bedside examination was performed by the speech-language pathology team, followed by a modified barium swallow or fiberoptic endoscopic evaluation of swallowing. A total of 321 patients were referred for evaluation. Twenty-four patients were unable to complete the evaluation. Clinical signs of aspiration were apparent in 160 patients (54%). Deep laryngeal penetration or aspiration were identified in 198 (67%) patients during instrumental testing. A group of 81 patients (27%) had an entirely normal clinical examination, but were found to have either deep penetration or aspiration. The majority of patients aspirate after lung transplantation. Clinical bedside examination is not sensitive enough and will fail to identify patients with silent aspiration. A standard of practice following lung transplantation has been established that helpsavoid postoperative aspiration associated with complications.

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

Introduction: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when the facility of a direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to the subjective nature of NIHSS administration. We aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. Patients and Methods: Ninety stroke patients within 48 h of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing (HQ-VTC), assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. Results: Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6-92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted kappa for total NIHSS score was 0.91 (95% CI 0.87-0.95). Minimal agreements were for commands (k = 0.46), facial palsy (k = 0.43), and ataxia (k = 0.27). Remote assessments were longer than bedside: 8 min (interquartile range, IQR 7-9) vs. 6 (IQR 5-8), p < 0.001. Conclusions: NIHSS-telestroke assessment using HQ-VTC in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

Mirror Image Video Artifact: An Under-Reported Digital Video-EEG Artifact

Synchronous video recording can be helpful in EEG recordings, especially in recognition of seizures and in rejection of artifacts. However, video recordings themselves are also subject to the risk of contamination by artifacts. We report a unique case in which a digital video artifact was identified, occurring during synchronous video-EEG recording, albeit independently of the EEG tracing itself. A synchronous digital video-EEG recording was performed on a 67-year-old male who presented in focal motor status epilepticus. During the initial review of the data, right-sided abnormalities on EEG apparently corresponded with (ipsilateral) right arm motor activity on video, suggesting a nonsensical anatomical localization. However, review of the patient’s chart and discussion with the EEG technologist led to the recognition that the video data recorded a mirror image of the true findings of left arm motor activity. Review of the software settings led to the discovery that the video recording was inverted along the vertical axis, leading to mirror image video artifact. Recognition of this video artifact allowed for accurate interpretation of the study—that right hemispheric EEG abnormalities correlated appropriately with (contralateral) left arm twitching. Effective communication between the EEG reading physician, the treating team, and the EEG technologist is critical for recognition of such artifacts, for proper EEG interpretation, and for appropriate patient management. Mirror image video artifact affirms that bedside evaluation, astute technologists, and attentive EEG reading physicians remain important, even in the presence of video recording.

Update on Thrombocytopenia in Pregnancy and Neuraxial Anesthesia

Historically, thrombocytopenia in pregnancy has been considered by many to be a relative contraindication to neuraxial placement secondary to the concern for spinal and epidural hematoma. More recent studies have attempted to further quantify this true risk by considering the etiology of thrombocytopenia and the absolute platelet count when epidurals were performed in parturients. We have described the most common etiologies of thrombocytopenia in pregnancy and the current tools available for bedside evaluation. We have reviewed the most recent literature and determined that multiple centers support the safe placement of neuraxial procedures in asymptomatic parturients with a platelet count >75,000 to 80,000/mm3 and even suggest that values above 60,000/mm3 could be acceptable in non-preeclamptic patients with thrombocytopenia depending on the specific etiology.

Somatosensory Test Responses and Physical and Psychological Functioning of Children and Adolescents with Chronic Non-neuropathic Pain: An Exploratory Study.

This study was designed to establish preliminary feasibility testing of a set of inherently benign somatosensory stimulus-response tests (to cutaneous and deep stimuli) for bedside or office evaluation of pain disorders in children and adolescents. Associations between, and the relative influence of, cutaneous somatosensory testing (SST) responses, deep SST responses, and psychological factors (depression, pain-related catastrophizing) on pain outcomes (worst pain intensity, pain-related disability) were considered. Sixty participants (6 to 18 y) were recruited from the pediatric chronic pain clinic. SST responses were assessed at the pain site (PS) and control sites to diverse stimuli (static/dynamic touch, punctate pressure, vibration, cool, deep pressure) using Colored Analogue Scales (CAS) with modified anchors. Validated measures of depression, pain-related catastrophizing, and pain-related functional interference were administered. Responses at the PS were more frequently hypersensitive than hyposensitive for all SST measures except vibration. Deep pressure responses were the only statistically significant predictor of worst pain intensity. Depression and pain-related catastrophizing accounted for a statistically significant amount of variance of pain-related disability, over and above that which was accounted for by SST responses. Preliminary feasibility of a set of somatosensory stimulus-response tests for bedside or office evaluation of pain disorders in children and adolescents was established. Deep pressure responses contributed unique information in predicting worst pain intensity but not functional interference. Although cutaneous SST responses at the PSs were frequently abnormal, cutaneous SST responses were not confirmed in this study to have clinical utility, but rather might be centrally mediated epiphenomena.