The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis

Fleming, Susannah; Gill, Peter; Jones, Caroline; Taylor, James A.; Bruel, Ann Van den; Heneghan, Carl; Roberts, Nia; Thompson, Matthew

doi:10.1371/journal.pone.0138155

Cited by 76 publications

(83 citation statements)

References 26 publications

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“…CRT is an index of circulatory management that can be evaluated noninvasively and repeatedly over time. Correlations between CRT and ScvO 2 as well as between abnormal CRT and mortality have also been reported,473 and the use of CRT as an indicator of hemodynamic status is believed to offer substantial benefits to patients.…”

Section: Cq19: Pediatric Considerationsmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq19: Pediatric Considerationsmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

View full text Add to dashboard Cite

show abstract

“…Odds ratios of 2-5 are reported for urinary tract infections and pneumonia, supporting the suggestion that a prolonged CRT is a red flag for serious illness in children, but, importantly, a normal CRT does not make a serious illness less likely. 4 Although studies from settings with high mortality (low income or high acuity) show that prolonged CRT is predictive of death, with a specificity of 92% (95% confidence interval = 89 to 95%), we do not know if these results apply to children in loweracuity settings. 4 Again, sensitivity was low (35%), meaning that a normal CRT should not be used for reassurance.…”

Section: What Is the Diagnostic And Prognostic Value Of Crt?mentioning

confidence: 87%

“…4 Although studies from settings with high mortality (low income or high acuity) show that prolonged CRT is predictive of death, with a specificity of 92% (95% confidence interval = 89 to 95%), we do not know if these results apply to children in loweracuity settings. 4 Again, sensitivity was low (35%), meaning that a normal CRT should not be used for reassurance.…”

Section: What Is the Diagnostic And Prognostic Value Of Crt?mentioning

confidence: 87%

“…4 In addition, several studies show that prolonged CRT has high specificity for predicting a variety of serious conditions in children, including meningitis, sepsis, and hypoxia, along with the need for hospital admission. Odds ratios of 2-5 are reported for urinary tract infections and pneumonia, supporting the suggestion that a prolonged CRT is a red flag for serious illness in children, but, importantly, a normal CRT does not make a serious illness less likely.…”

Section: What Is the Diagnostic And Prognostic Value Of Crt?mentioning

confidence: 99%

“…Prolonged CRT is a 'red flag' feature, identifying children with increased risk of significant morbidity or mortality. [1][2][3][4] Although national and international guidelines, including National Institute for Health and Care Excellence guidelines, recommend the use of CRT as part of the initial assessment of unwell children, 1,2 it is infrequently measured in general practice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Capillary refill time in sick children: a clinical guide for general practice

et al. 2016

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

Egi

Ogura

Yatabe

et al. 2021

Acute Medicine & Surgery

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created as revised from J‐SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high‐quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J‐SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU‐acquired weakness [ICU‐AW], post‐intensive care syndrome [PICS], and body temperature management). The J‐SSCG 2020 covered a total of 22 areas with four additional new areas (patient‐ and family‐centered care, sepsis treatment system, neuro‐intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large‐scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE‐based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J‐SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis

Cited by 76 publications

References 26 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Capillary refill time in sick children: a clinical guide for general practice

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020)

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