The agreement of fingertip and sternum capillary refill time in children

Area of Science:

• Pediatric emergency medicine
• Clinical assessment techniques
• Hemodynamic monitoring

Background:

• Capillary refill time (CRT) is a commonly used clinical indicator to assess peripheral circulation and hydration status in children.
• Standardization of CRT measurement sites is crucial for reliable clinical assessment.
• Previous studies have suggested variations in CRT measurements depending on the site.

Purpose of the Study:

• To evaluate the agreement between fingertip and sternum capillary refill time (CRT) measurements in pediatric patients.
• To determine if fingertip CRT can be used interchangeably with sternum CRT for assessing circulation in children.

Main Methods:

• A prospective method-comparison study was conducted in a single UK children's emergency department.
• Ninety-two children aged 0-12 years with minor illnesses or injuries and normal clinical observations were included.
• Agreement between fingertip and sternum CRT measurements was assessed using statistical analysis, including Bland Altman plots.

Main Results:

• Fingertip CRT ranged from 0.05 to 2.78 seconds (mean 1.08±0.44 s), while sternum CRT ranged from 0.85 to 2.38 seconds (mean 1.5±0.33 s).
• A significant difference was found between fingertip and sternum CRT (p<0.001), with a weak association (r=0.18).
• Bland Altman analysis revealed a mean difference of -0.49±0.51 seconds, indicating poor agreement.

Conclusions:

• Measurements of capillary refill time at the fingertip and sternum are not comparable in children.
• Fingertip CRT measurements were consistently faster than sternum CRT.
• The findings question the clinical usefulness of fingertip CRT for assessing circulation in children, especially when compared to sternum measurements.