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Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb
Published on: December 2, 2017
Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
Samuele Caruggi1, Martina Rossi1, Costantino De Giacomo2
1Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy.
Insights
Capillary refilling time is a reliable and valid tool for assessing dehydration in children during emergency department triage. This quick method helps identify children needing prompt rehydration.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Triage
- Diagnostic Accuracy
Background:
- Dehydration is a critical pediatric condition requiring rapid assessment in emergency settings.
- Current triage parameters for pediatric dehydration lack standardization.
Purpose of the Study:
- To evaluate the reliability and validity of capillary refilling time (RT) as a triage tool for pediatric dehydration.
- To assess RT's effectiveness in identifying children requiring immediate rehydration.
Main Methods:
- Prospective pilot cohort study in two Italian pediatric emergency departments.
- Assessed interobserver reliability between nurses and physicians.
- Correlated RT with percentage of weight loss and a validated Clinical Dehydration Score (CDS).
- Used receiver operating characteristic (ROC) curve analysis to evaluate discriminative ability for intravenous rehydration therapy.
Main Results:
- 242 children participated; nurses found RT easy to perform after training.
- Fair interobserver reliability (Cohen's kappa = 0.56).
- Significant correlation between RT and percentage weight loss (r-squared = -0.27).
- Area under the ROC curve (AUC) for RT was 0.65, comparable to the CDS AUC.
Conclusions:
- Capillary refilling time is a fast and practical tool for recognizing dehydrated children in triage.
- RT can be effectively integrated into emergency department triage protocols for prompt rehydration decisions.
Purpose:
Dehydration is a paediatric medical emergency but there is no single standard parameter to evaluate it at the emergency department. Our aim was to evaluate the reliability and validity of capillary refilling time as a triage parameter to assess dehydration in children.
Methods:
This was a prospective pilot cohort study of children who presented to two paediatric emergency departments in Italy, with symptoms of dehydration. Reliability was assessed by comparing the triage nurse's measurements with those obtained by the physician. Validity was demonstrated by using 6 parameters suggestive of dehydration. Comparison between refilling time (RT) and a validated Clinical Dehydration Score (CDS) was also considered. The scale's discriminative ability was evaluated for the outcome of starting intravenous rehydration therapy by using a receiver operating characteristic (ROC) curve.
Results:
Participants were 242 children. All nurses found easy to elicit the RT after being trained. Interobserver reliability was fair, with a Cohen's kappa of 0.56 (95% confidence interval [CI], 0.41 to 0.70). There was a significant correlation between RT and weight loss percentage (r-squared=-0.27; 95% CI, -0.47 to -0.04). The scale's discriminative ability yielded an area under the ROC curve (AUC) of 0.65 (95% CI, 0.57 to 0.73). We found a similarity between RT AUC and CDS-scale AUC matching the two ROC curves.
Conclusion:
The study showed that RT represents a fast and handy tool to recognize dehydrated children who need a prompt rehydration and may be introduced in the triage line-up.
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