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Effect of ambient temperature on capillary refill in healthy children
M H Gorelick1, K N Shaw, M D Baker
1Division of General Pediatrics, Children's Hospital of Philadelphia, PA 19010.
Insights
Cooler temperatures significantly prolong capillary refill (CR) time in children, impacting its reliability for assessing circulation. Even trained observers show variability in CR measurements, suggesting caution when using this method.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Physiology
Background:
- Capillary refill (CR) time is a clinical indicator of peripheral circulation.
- Assessing CR in children is crucial in emergency settings.
- Environmental factors and observer variability may influence CR measurements.
Purpose of the Study:
- To evaluate the impact of moderately decreased ambient temperature on capillary refill time in healthy children.
- To determine the interobserver reliability of CR measurements in a pediatric population.
Main Methods:
- Prospective, cross-over study involving 32 healthy children (1 month to 12 years).
- Participants experienced 15-minute periods in both a warm (25.7°C) and cool (19.4°C) room.
- Fingertip CR was measured three times by trained observers using a stopwatch.
Main Results:
- Mean CR time was significantly longer in the cool room (2.39s) compared to the warm room (0.85s) (P < .001).
- Normal CR (<2s) was observed in 100% of children in the warm room versus 31% in the cool room.
- Interobserver reliability for CR measurement was fair (ICC 0.70, kappa 0.54).
Conclusions:
- Ambient temperature reductions, even within typical office/ED ranges, can significantly prolong CR time in children.
- CR measurement exhibits considerable interobserver variability, even among experienced clinicians.
- The findings highlight limitations in using CR time for assessing pediatric patients, particularly in varying environmental conditions.
Objectives:
To assess the effect of moderately decreased ambient temperature on capillary refill (CR) time in healthy children, and to measure the reliability of CR measurements between observers.
Design:
Prospective interventional study with cross-over design.
Setting:
Urban pediatric emergency department.
Participants:
32 well-hydrated children aged 1 month to 12 years brought to the emergency department for care of minor illness or injury.
Interventions:
Participants were assigned in random order to a 15-minute waiting period in each of two rooms, with and without air-conditioning (cool and warm rooms, respectively). At the end of each waiting period, fingertip CR was measured with a stopwatch, three times by each of one or more three trained observers.
Results:
Mean CR time was 0.85 +/- 0.45 seconds in the warm room (mean ambient temperature (25.7 degrees C) vs 2.39 +/- 0.76 seconds in the cool room (mean temperature 19.4 degrees C). The mean overall difference in CR time between the two environments was 1.53 seconds (95% confidence interval [CI]: 1.31, 1.75; P < .001); the difference was significant regardless of age or sequence of exposure. 100% of patients were considered to have normal CR (less than 2 seconds) in the warm room, whereas only 31% were considered normal in the cool room. In the 16 patients with CR measured by three observers, interobserver reliability was fair, with an intraclass correlation coefficient of 0.70 (95% CI: 0.56, 0.85), and kappa of 0.54 (95% CI: 0.33, 0.73).
Conclusions:
Decreases in ambient temperature within a range found in typical office/emergency department settings may cause significant prolongation of CR time in children with normal circulatory status. There is marked interobserver variability in the measurement of CR even when performed by experienced observers. These findings suggest limitations to the use of CR in the assessment of ill or injured children.