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Effect of fever on capillary refill time
M H Gorelick1, K N Shaw, K O Murphy
1Division of Emergency Medicine, Children's Hospital of Philadelphia, PA 19104-4399, USA.
Insights
Fever does not significantly impact capillary refill time in children, a key indicator of hydration status. This finding is crucial for accurate dehydration assessment in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Assessment
- Hydration Status Evaluation
Background:
- Capillary refill time (CRT) is a common bedside test to assess hydration in children.
- Fever is a frequent symptom in pediatric illness and may influence physiological parameters.
- The impact of fever on CRT accuracy in diagnosing dehydration requires clarification.
Purpose of the Study:
- To evaluate the influence of fever on capillary refill time measurements in children.
- To determine if fever affects the reliability of CRT as an indicator of dehydration in pediatric patients.
Main Methods:
- Prospective cohort study involving 234 children (1 month to 5 years) presenting to a pediatric emergency department.
- Capillary refill time was measured before therapy.
- Body temperature and fluid deficit (calculated from weight changes) were assessed to determine hydration status.
Main Results:
- Children with dehydration (>5% body weight deficit) had significantly longer CRT (2.0 ± 1.0s) compared to well-hydrated children (1.3 ± 0.5s).
- Febrile children showed no significant difference in CRT compared to non-febrile children within both dehydrated and well-hydrated groups.
- The diagnostic performance of CRT for dehydration remained consistent regardless of fever presence.
Conclusions:
- Fever does not appear to have a clinically significant effect on capillary refill time in children.
- CRT remains a valuable tool for assessing dehydration in pediatric patients, even when fever is present.
Objective:
To assess the effect of fever on capillary refill time in children.
Design:
Prospective cohort study.
Setting:
Tertiary care children's hospital emergency department (ED).
Participants:
Convenience sample of 234 children age one month to five years presenting to the ED with a complaint of vomiting, diarrhea, or poor oral fluid intake.
Intervention:
None.
Measurements:
Before any therapy, capillary refill was measured according to a standard protocol. Rectal temperature was measured in children less than three years old, oral temperature in older children. Fluid deficit was calculated as the percentage difference between initial weight and stable weight following treatment.
Main Results:
Among the 80 children with dehydration, defined as a deficit of > or = 5% of body weight, mean capillary refill was 2.0 +/- 1.0 seconds, versus 1.3 +/- 0.5 seconds in the well hydrated group (P < 0.001). Within each group, mean capillary refill time for febrile patients (temperature > or = 38.3 degrees C) was essentially the same as in those without fever. Using a two-second upper limit of normal, prolonged capillary refill had a sensitivity of 0.44 and specificity of 0.94 for diagnosing dehydration; the diagnostic performance did not differ when stratified by presence or absence of fever.
Conclusions:
Presence of fever does not have a clinically important effect on capillary refill time in children.