Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs
1
Issued Date
2022-04-01
Resource Type
ISSN
18639933
eISSN
16153146
Scopus ID
2-s2.0-85099773454
Pubmed ID
33475776
Journal Title
European Journal of Trauma and Emergency Surgery
Volume
48
Issue
2
Start Page
1231
End Page
1237
Rights Holder(s)
SCOPUS
Bibliographic Citation
European Journal of Trauma and Emergency Surgery Vol.48 No.2 (2022) , 1231-1237
Suggested Citation
Monteerarat Y. Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs. European Journal of Trauma and Emergency Surgery Vol.48 No.2 (2022) , 1231-1237. 1237. doi:10.1007/s00068-020-01594-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/86021
Title
Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Purpose: No standardized execution or evidence demonstrates the area of the digit giving the most accurate capillary refill time (CRT). This study investigated the reliability and validity of CRT, and the relative merits of areas where the test could be performed. Methods: In all, 127 healthy volunteers were assessed for normal CRT at the fingernail, lateral paronychia, and proximal and distal pulps of the index finger. The predictive validity of the CRT for the diagnosis of compromised vascular perfusion was also investigated on 24 subjects, using an inflated tourniquet. Three raters assessed interobserver reliability. Results: The mean fingernail, lateral paronychia, proximal pulp, and distal pulp CRTs were 1.93, 1.78, 1.70, and 1.57 s, respectively. The tourniquet and non-tourniquet results demonstrated significant mean differences; however, the fingernail showed a subtle difference (1.22 s) compared with the proximal pulp (4.46 s). The CRT interobserver reliability was fair at the fingernail (intraclass correlation coefficient [ICC] = 0.51), but very poor in occluded limbs (ICC = 0.13). At the lateral paronychia and finger pulp, the interobserver reliability was reasonable (ICC = 0.75–0.81 [non-tourniquet] vs 0.62–0.68 [tourniquet]). In a receiver-operating characteristic curve analysis, the proximal pulp demonstrated better discrimination (area under the curve = 0.93, 95% CI 0.89–0.97, p < 0.0001); the best cutoff point was calculated to be 3 s at the proximal pulp. Conclusions: CRT use at appropriate areas is reliable. The most dependable site is the finger pulp, and the proposed cutoff is 3 s.