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Updated: Jul 18, 2026
Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb
Published on: December 2, 2017
Capillary refill time as an independent prognostic indicator in severe and complicated malaria
Jennifer A Evans1, Juergen May, Daniel Ansong
1Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana. evans@kccr.de
Insights
Prolonged capillary refill time (pCRT) in children with severe malaria is a key indicator of death. This finding improves malaria risk assessment and guides fluid resuscitation in endemic areas.
Area of Science:
- Pediatrics
- Infectious Diseases
- Tropical Medicine
Background:
- Malaria remains a leading cause of childhood mortality in endemic regions.
- Accurate identification of children at high risk of death from severe malaria is crucial for timely intervention.
Purpose of the Study:
- To enhance algorithms for identifying children at risk of mortality from malaria.
- To evaluate clinical and laboratory signs as predictors of death in severe malaria.
Main Methods:
- Prospective study involving 2446 children with severe and complicated malaria.
- Evaluation of 12 clinical and laboratory signs as indicators of mortality.
Main Results:
- Prolonged capillary refill time (pCRT) (> 2 seconds) identified as an independent prognostic indicator of death.
- pCRT, along with acidosis, coma, and respiratory distress, significantly increases the risk of mortality.
- pCRT in conjunction with coma and respiratory distress elevated the risk of death 4-fold to 11-fold.
Conclusions:
- pCRT should be incorporated as a criterion for defining severe and complicated malaria.
- The inclusion of pCRT enhances clinical assessment and triage of malaria patients.
- pCRT's reflection of circulatory disturbances suggests its utility in guiding intravenous fluid administration.
Objectives:
To improve algorithms for the identification of children at risk of dying of malaria in endemic areas.
Study Design:
In a prospective study of 2446 children with severe and complicated malaria admitted to a tertiary referral center in Ghana, West Africa, 12 clinical and laboratory signs were evaluated as indicators of death.
Results:
A prolonged (> 2 seconds) capillary refill time (pCRT) was identified as an independent prognostic indicator of death along with acidosis, coma, and respiratory distress. Among the clinical signs, pCRT increased the risk of dying from 4-fold to 11-fold when present in addition to coma and respiratory distress.
Conclusions:
The recognition of pCRT as an independent indicator of death justifies its inclusion as a defining criterion of severe and complicated malaria and improves the use of clinical examinations in the triage of patients with malaria. As pCRT has been shown to reflect circulatory disturbances in children, it should be included in upcoming studies as a possible sign to indicate the need for intravenous fluid administration.
