Susannah Fleming1, Peter Gill2, Caroline Jones1, James A Taylor3, Ann Van den Bruel1, Carl Heneghan1, Matthew Thompson4. 1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 2. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada. 3. Child Health Institute, University of Washington, Seattle, USA. 4. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Department of Family Medicine, University of Washington, Seattle, USA.
Abstract
BACKGROUND: Most guidelines recommend the use of capillary refill time (CRT) as part of the routine assessment of unwell children, but there is little consensus on the optimum method of measurement and cut-off time. METHODS: We searched Medline (from 1948), Embase (from 1980) and CINAHL (from 1991) to June 2014 to identify studies with information on the normal range of CRT in healthy children, the validity of CRT compared with reference standard measures of haemodynamic status, reliability and factors influencing measurement of CRT, such as body site, pressing time and temperature. FINDINGS: We included 21 studies on 1915 children. Four studies provided information on the relationship between CRT and measures of cardiovascular status, 13 provided data on the normal range of CRT, 7 provided data on reliability and 10 assessed the effect of various confounding factors. In children over 7 days of age, the upper limit of normal CRT is approximately 2 s when measured on a finger, and 4 s when measured on the chest or foot, irrespective of whether the child is feverish or not. Longer pressing times and ambient temperature outside 20°C-25°C are associated with longer CRT. Evidence suggests that the use of stopwatches reduces variability between observers. INTERPRETATION: We recommend use of the following standardised CRT method of measurement: press on the finger for 5 s using moderate pressure at an ambient temperature of 20°C-25°C. A capillary refill time of 3 s or more should be considered abnormal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: Most guidelines recommend the use of capillary refill time (CRT) as part of the routine assessment of unwell children, but there is little consensus on the optimum method of measurement and cut-off time. METHODS: We searched Medline (from 1948), Embase (from 1980) and CINAHL (from 1991) to June 2014 to identify studies with information on the normal range of CRT in healthy children, the validity of CRT compared with reference standard measures of haemodynamic status, reliability and factors influencing measurement of CRT, such as body site, pressing time and temperature. FINDINGS: We included 21 studies on 1915 children. Four studies provided information on the relationship between CRT and measures of cardiovascular status, 13 provided data on the normal range of CRT, 7 provided data on reliability and 10 assessed the effect of various confounding factors. In children over 7 days of age, the upper limit of normal CRT is approximately 2 s when measured on a finger, and 4 s when measured on the chest or foot, irrespective of whether the child is feverish or not. Longer pressing times and ambient temperature outside 20°C-25°C are associated with longer CRT. Evidence suggests that the use of stopwatches reduces variability between observers. INTERPRETATION: We recommend use of the following standardised CRT method of measurement: press on the finger for 5 s using moderate pressure at an ambient temperature of 20°C-25°C. A capillary refill time of 3 s or more should be considered abnormal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Evidence Based Medicine; General Paediatrics; Measurement
Authors: Amanda J Nickel; Shen Jiang; Natalie Napolitano; Nadir Yehya; Julie C Fitzgerald; Benjamin B Bruins; Justin L Lockman; Vinay M Nadkarni; Akira Nishisaki Journal: Crit Care Med Date: 2020-10 Impact factor: 9.296
Authors: Susannah Fleming; Peter Gill; Caroline Jones; James A Taylor; Ann Van den Bruel; Carl Heneghan; Nia Roberts; Matthew Thompson Journal: PLoS One Date: 2015-09-16 Impact factor: 3.240
Authors: L L Blaxter; D E Morris; J A Crowe; C Henry; S Hill; D Sharkey; H Vyas; B R Hayes-Gill Journal: Physiol Meas Date: 2015-12-07 Impact factor: 2.833