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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
A novel imaging technique to measure capillary-refill time: improving diagnostic accuracy for dehydration in young
Itai Shavit1, Rollin Brant, Cheri Nijssen-Jordan
1Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Digital videography offers a more accurate way to assess dehydration in young children. Digitally measured capillary-refill time (CRT) better predicts significant dehydration than clinical judgment alone.
Area of Science:
- Pediatric emergency medicine
- Diagnostic accuracy
- Dehydration assessment
Background:
- Clinical judgment for dehydration in children is often inaccurate.
- Digital videography enables objective assessment of capillary-refill time (CRT).
Purpose of the Study:
- To compare the accuracy of digitally measured CRT versus conventional methods for detecting significant dehydration (≥5%) in children with gastroenteritis.
Main Methods:
- Prospective enrollment of 83 children (1 month-5 years) with gastroenteritis and suspected dehydration.
- Digital and conventional CRT measurements, clinical assessment, and weight-based fluid deficit estimation.
- Comparison of diagnostic accuracy using receiver operator characteristic curves and likelihood ratios.
Main Results:
- Digitally measured CRT demonstrated a higher area under the curve (0.99) compared to overall clinical assessment (0.88).
- Positive likelihood ratios were 11.7 for digital CRT, 4.5 for conventional CRT, and 4.1 for clinical assessment.
- 13 out of 83 patients had significant dehydration (≥5% body weight).
Conclusions:
- Digitally measured CRT is a more accurate predictor of significant dehydration in young children with gastroenteritis.
- This objective method surpasses traditional clinical assessment for identifying dehydration severity.
Background:
Assessment of dehydration in young children currently depends on clinical judgment, which is relatively inaccurate. By using digital videography, we developed a way to assess capillary-refill time more objectively.
Objective:
Our goal was to determine whether digitally measured capillary-refill time assesses the presence of significant dehydration (> or = 5%) in young children with gastroenteritis more accurately than conventional capillary refill and overall clinical assessment.
Methods:
We prospectively enrolled children with gastroenteritis, 1 month to 5 years of age, who were evaluated in a tertiary-care pediatric emergency department and judged by a triage nurse to be at least mildly dehydrated. Before any treatment, we measured the weight and digitally measured capillary-refill time of these children. Pediatric emergency physicians determined capillary-refill time by using conventional methods and degree of dehydration by overall clinical assessment by using a 7-point Likert scale. Postillness weight gain was used to estimate fluid deficit; beginning 48 hours after assessment, children were reweighed every 24 hours until 2 sequential weights differed by no more than 2%. We compared the accuracy of digitally measured capillary-refill time with conventional capillary refill and overall clinical assessment by determining sensitivities, specificities, likelihood ratios, and area under the receiver operator characteristic curves.
Results:
A total of 83 patients were enrolled and had complete follow-up; 13 of these patients had significant dehydration (> or = 5% of body weight). The area under the receiver operator characteristic curves for digitally measured capillary-refill time and overall clinical assessment relative to fluid deficit (< 5% vs > or = 5%) were 0.99 and 0.88, respectively. Positive likelihood ratios were 11.7 for digitally measured capillary-refill time, 4.5 for conventional capillary refill, and 4.1 for overall clinical assessment.
Conclusions:
Results of this prospective cohort study suggest that digitally measured capillary-refill time more accurately predicts significant dehydration (> or = 5%) in young children with gastroenteritis than overall clinical assessment.
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