Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study

Mrgan, Monija; Rytter, Dorte; Brabrand, Mikkel

doi:10.1136/emermed-2013-202925

Cited by 24 publications

(18 citation statements)

References 15 publications

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“…Hypertensive retinopathy provides evidence of target organ damage and some features predict increased risk of CVS disease 63 AR=aortic regurgitation; AS=aortic stenosis; CHF=congestive heart failure; CVS=cardiovascular system; HCM=hypertrophic obstructive cardiomyopathy; IHD=ischaemic heart disease; LR=likelihood ratio; LV=left ventricular; MI=myocardial infarction; PAD=peripheral arterial disease; PHT=pulmonary hypertension; SVR=systemic vascular resistance. 82 Physical examination signs of impaired peripheral perfusion may therefore hold both diagnostic and prognostic value in shock syndromes. Accordingly, assessment of capillary refill time and other markers of peripheral perfusion is recommended for the initial rapid evaluation of circulatory status in a wide variety of settings.…”

Section: Detailed Discussion Of Selected Signsmentioning

confidence: 99%

How valuable is physical examination of the cardiovascular system?

Elder¹,

Japp²,

Verghese

2016

BMJ

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Physical examination of the cardiovascular system is central to contemporary teaching and practice in clinical medicine. Evidence about its value focuses on its diagnostic accuracy and varies widely in methodological quality and statistical power. This makes collation, analysis, and understanding of results difficult and limits their application to daily clinical practice. Specific factors affecting interpretation and clinical application include poor standardisation of observers' technique and training, the study of single signs rather than multiple signs or signs in combination with symptoms, and the tendency to compare physical examination directly with technological aids to diagnosis rather than explore diagnostic strategies that combine both. Other potential aspects of the value of physical examination, such as cost effectiveness or patients' perceptions, are poorly studied. This review summarises the evidence for the clinical value of physical examination of the cardiovascular system. The best was judged to relate to the detection and evaluation of valvular heart disease, the diagnosis and treatment of heart failure, the jugular venous pulse in the assessment of central venous pressure, and the detection of atrial fibrillation, peripheral arterial disease, impaired perfusion, and aortic and carotid disease. Although technological aids to diagnosis are likely to become even more widely available at the point of care, the evidence suggests that further research into the value of physical examination of the cardiovascular system is needed, particularly in low resource settings and as a potential means of limiting inappropriate overuse of technological aids to diagnosis.

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Section: Detailed Discussion Of Selected Signsmentioning

confidence: 99%

How valuable is physical examination of the cardiovascular system?

Elder¹,

Japp²,

Verghese

2016

BMJ

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“…Guidelines commonly state that refill should occur within 2 to 3 seconds following 5 seconds firm pressure in the healthy supine patient [1,2]. The CR test is performed to obtain an early indication of incipient circulatory collapse [3][4][5]. A variable 5% to 70% of the cardiac output is distributed to the microcirculation of the skin [6], and poor skin perfusion will result in slower refill time.…”

Section: Introductionmentioning

confidence: 99%

A cool response—The influence of ambient temperature on capillary refill time

John

Henricson

Junker

et al. 2018

Journal of Biophotonics

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“…Application of a firm blanching pressure to the skin with subsequent observation of the return of blood flow to the blanched area is termed the capillary refill (CR) test. The purpose of the CR test is to obtain an earlier indication of incipient circulatory collapse, since changes in CR may occur earlier than changes in the traditional vital parameters and the clinical signs of cold, clammy and mottled skin. Guidelines commonly state that refill should occur within 2 seconds after 5 seconds of firm pressure (e. g. by the physician's finger) in the normal healthy supine patient .…”

Section: Introductionmentioning

confidence: 99%

Reflectance spectroscopy: to shed new light on the capillary refill test

John

Henricson

Nilsson³

et al. 2017

Journal of Biophotonics

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To use Bioengineering methodology is used to achieve, at five anatomical sites, a detailed, quantitative assessment of the return of blood content to the blanched area, during the Capillary Refill (CR) test. An observational, non-randomized, experimental study on 23 healthy subjects (14 females) was performed in our climate controlled skin physiology laboratory. Our main outcome measures were based on the chronological assessment and quantification of red blood cell concentration (RBC) after the release of blanching pressure in the CR test, using Tissue Viability Imaging (TiVi), a digital photographic technique based on polarisation spectroscopy. TiVi enabled collection of detailed data on skin RBC concentration during the CR test. The results were shown as curves with skin blood concentration (TiVi-value) on the y-axis and the time on the x-axis. Quantitative CR responses showed site and temperature variability. We also suggest possible objective endpoint values from the capillary refill curve. Detailed data on skin RBC concentration during the CR test is easily obtained and allows objective determination of end points not possible to achieve by naked eye assessment. These findings have the potential to place the utility of the CR test in a clinical setting in a new light.

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Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study

Abstract: We found a significant association between CRT measured as a continuous variable and short-term mortality. Using the definition of Schriger and Baraff also seems appropriate, but this is based on calculations of limited power.

Cited by 24 publications

References 15 publications

How valuable is physical examination of the cardiovascular system?

How valuable is physical examination of the cardiovascular system?

A cool response—The influence of ambient temperature on capillary refill time

Reflectance spectroscopy: to shed new light on the capillary refill test

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