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Updated: Apr 23, 2026
Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb
Published on: December 2, 2017
Validity and reliability of measurement of capillary refill time in children: a systematic review
Susannah Fleming1, Peter Gill2, Caroline Jones1
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
Capillary refill time (CRT) measurement in children needs standardization. A finger press for 5 seconds at 20-25°C is recommended, with a CRT of 3 seconds or more indicating abnormality.
Area of Science:
- Pediatric assessment
- Hemodynamic monitoring
- Clinical diagnostics
Background:
- Capillary refill time (CRT) is recommended for assessing unwell children.
- Optimal CRT measurement methods and cut-off times lack consensus.
- Standardization is crucial for reliable pediatric assessment.
Purpose of the Study:
- To review evidence on normal CRT ranges in healthy children.
- To evaluate CRT validity against hemodynamic status measures.
- To identify factors influencing CRT measurement and reliability.
Main Methods:
- Systematic literature search of Medline, Embase, and CINAHL up to June 2014.
- Inclusion of 21 studies involving 1915 children.
- Analysis of data on normal ranges, validity, reliability, and confounding factors.
Main Results:
- Upper limit of normal CRT is ~2s (finger) and ~4s (chest/foot) for children >7 days old.
- Longer CRT associated with prolonged pressure and temperatures outside 20°C-25°C.
- Stopwatch use reduces observer variability in CRT measurement.
Conclusions:
- Recommend standardized CRT measurement: 5s finger press, 20°C-25°C ambient temperature.
- A CRT of ≥3s should be considered abnormal.
- Standardized CRT improves reliability in pediatric assessment.
Background:
Most guidelines recommend the use of capillary refill time (CRT) as part of the routine assessment of unwell children, but there is little consensus on the optimum method of measurement and cut-off time.
Methods:
We searched Medline (from 1948), Embase (from 1980) and CINAHL (from 1991) to June 2014 to identify studies with information on the normal range of CRT in healthy children, the validity of CRT compared with reference standard measures of haemodynamic status, reliability and factors influencing measurement of CRT, such as body site, pressing time and temperature.
Findings:
We included 21 studies on 1915 children. Four studies provided information on the relationship between CRT and measures of cardiovascular status, 13 provided data on the normal range of CRT, 7 provided data on reliability and 10 assessed the effect of various confounding factors. In children over 7 days of age, the upper limit of normal CRT is approximately 2 s when measured on a finger, and 4 s when measured on the chest or foot, irrespective of whether the child is feverish or not. Longer pressing times and ambient temperature outside 20°C-25°C are associated with longer CRT. Evidence suggests that the use of stopwatches reduces variability between observers.
Interpretation:
We recommend use of the following standardised CRT method of measurement: press on the finger for 5 s using moderate pressure at an ambient temperature of 20°C-25°C. A capillary refill time of 3 s or more should be considered abnormal.
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