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. 2004 Oct;89(10):950–955. doi: 10.1136/adc.2003.032516

Capillary refill: prognostic value in Kenyan children

A Pamba 1, K Maitland 1
PMCID: PMC1719664  PMID: 15383440

Abstract

Aims: To determine whether delayed capillary refill time (>3 seconds) is a useful prognostic indicator in Kenyan children admitted to hospital.

Methods: A total of 4160 children admitted to Kilifi District Hospital with malaria, malarial anaemia, acute respiratory tract infection (ARI), severe anaemia (haemoglobin <50 g/l), gastroenteritis, malnutrition, meningitis, or septicaemia were studied.

Results: Overall, delayed capillary refill time (dCRT), present in 346/4160 (8%) of the children, was significantly more common in fatal cases (44/189, 23%) than survivors (7.5%), and had useful prognostic value. In children admitted with malaria, gastroenteritis, or malnutrition, likelihood ratio tests suggested that dCRT was useful in identifying high risk groups for mortality, but its prognostic value in anaemia, ARI, and sepsis was unclear due to low case fatality or limited numbers. The severity features of impaired consciousness and deep breathing were significantly associated both with the presence of dCRT and fatal outcome. In children, with either of these severity features, a less stringent value of dCRT(>2 s) identified 50% of children with hypotension (systolic BP <2SD) and 40% of those requiring volume resuscitation (for metabolic acidosis).

Conclusions: Although CRT is a simple bedside test, which may be used in resource poor settings as a guide to the circulatory status, dCRT should not be relied on in the absence of other features of severity. In non-severe disease, the additional presence of hypoxia, a moderately raised creatinine (>80 µmol/l), or a raised white cell count should prompt the need for fluid expansion.

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Figure 1.

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 Capillary refill testing: a valuable triage sign?

Selected References

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  1. Ajayi-Obe E. K., Lodi E., Alkali A. S., Galbati M., Rooney C., Mannoni B., Grim P., Nasidi A., Mohammed I. Prognostic scores for use in African meningococcal epidemics. Bull World Health Organ. 1998;76(2):149–152. [PMC free article] [PubMed] [Google Scholar]
  2. Berkley J. A., Ross A., Mwangi I., Osier F. H. A., Mohammed M., Shebbe M., Lowe B. S., Marsh K., Newton C. R. J. C. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ. 2003 Feb 15;326(7385):361–361. doi: 10.1136/bmj.326.7385.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berkley J., Mwarumba S., Bramham K., Lowe B., Marsh K. Bacteraemia complicating severe malaria in children. Trans R Soc Trop Med Hyg. 1999 May-Jun;93(3):283–286. doi: 10.1016/s0035-9203(99)90024-x. [DOI] [PubMed] [Google Scholar]
  4. English M., Punt J., Mwangi I., McHugh K., Marsh K. Clinical overlap between malaria and severe pneumonia in Africa children in hospital. Trans R Soc Trop Med Hyg. 1996 Nov-Dec;90(6):658–662. doi: 10.1016/s0035-9203(96)90423-x. [DOI] [PubMed] [Google Scholar]
  5. English M., Sauerwein R., Waruiru C., Mosobo M., Obiero J., Lowe B., Marsh K. Acidosis in severe childhood malaria. QJM. 1997 Apr;90(4):263–270. doi: 10.1093/qjmed/90.4.263. [DOI] [PubMed] [Google Scholar]
  6. English M., Waruiru C., Amukoye E., Murphy S., Crawley J., Mwangi I., Peshu N., Marsh K. Deep breathing in children with severe malaria: indicator of metabolic acidosis and poor outcome. Am J Trop Med Hyg. 1996 Nov;55(5):521–524. doi: 10.4269/ajtmh.1996.55.521. [DOI] [PubMed] [Google Scholar]
  7. Gorelick M. H., Shaw K. N., Baker M. D. Effect of ambient temperature on capillary refill in healthy children. Pediatrics. 1993 Nov;92(5):699–702. [PubMed] [Google Scholar]
  8. Gorelick M. H., Shaw K. N., Murphy K. O. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997 May;99(5):E6–E6. doi: 10.1542/peds.99.5.e6. [DOI] [PubMed] [Google Scholar]
  9. Gove S., Tamburlini G., Molyneux E., Whitesell P., Campbell H. Development and technical basis of simplified guidelines for emergency triage assessment and treatment in developing countries. WHO Integrated Management of Childhood Illness (IMCI) Referral Care Project. Arch Dis Child. 1999 Dec;81(6):473–477. doi: 10.1136/adc.81.6.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Herson V. C., Todd J. K. Prediction of morbidity in Hemophilus influenzae meningitis. Pediatrics. 1977 Jan;59(1):35–39. [PubMed] [Google Scholar]
  11. Kothari S. S., Patel T. M., Shetalwad A. N., Patel T. K. Left ventricular mass and function in children with severe protein energy malnutrition. Int J Cardiol. 1992 Apr;35(1):19–25. doi: 10.1016/0167-5273(92)90050-d. [DOI] [PubMed] [Google Scholar]
  12. Maitland K., Levin M., English M., Mithwani S., Peshu N., Marsh K., Newton C. R. J. C. Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia. QJM. 2003 Jun;96(6):427–434. doi: 10.1093/qjmed/hcg077. [DOI] [PubMed] [Google Scholar]
  13. Maitland Kathryn, Pamba Allan, Newton Charles R. J. C., Levin Michael. Response to volume resuscitation in children with severe malaria. Pediatr Crit Care Med. 2003 Oct;4(4):426–431. doi: 10.1097/01.PCC.0000090293.32810.4E. [DOI] [PubMed] [Google Scholar]
  14. McGee S., Abernethy W. B., 3rd, Simel D. L. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999 Mar 17;281(11):1022–1029. doi: 10.1001/jama.281.11.1022. [DOI] [PubMed] [Google Scholar]
  15. Molyneux M. E., Taylor T. E., Wirima J. J., Borgstein A. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Q J Med. 1989 May;71(265):441–459. [PubMed] [Google Scholar]
  16. Otieno H., Were E., Ahmed I., Charo E., Brent A., Maitland K. Are bedside features of shock reproducible between different observers? Arch Dis Child. 2004 Oct;89(10):977–979. doi: 10.1136/adc.2003.043901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Powell K. R., Sugarman L. I., Eskenazi A. E., Woodin K. A., Kays M. A., McCormick K. L., Miller M. E., Sladek C. D. Normalization of plasma arginine vasopressin concentrations when children with meningitis are given maintenance plus replacement fluid therapy. J Pediatr. 1990 Oct;117(4):515–522. doi: 10.1016/s0022-3476(05)80682-1. [DOI] [PubMed] [Google Scholar]
  18. Robertson M. A., Molyneux E. M. Triage in the developing world--can it be done? Arch Dis Child. 2001 Sep;85(3):208–213. doi: 10.1136/adc.85.3.208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Saavedra J. M., Harris G. D., Li S., Finberg L. Capillary refilling (skin turgor) in the assessment of dehydration. Am J Dis Child. 1991 Mar;145(3):296–298. doi: 10.1001/archpedi.1991.02160030064022. [DOI] [PubMed] [Google Scholar]
  20. Schriger D. L., Baraff L. J. Capillary refill--is it a useful predictor of hypovolemic states? Ann Emerg Med. 1991 Jun;20(6):601–605. doi: 10.1016/s0196-0644(05)82375-3. [DOI] [PubMed] [Google Scholar]
  21. Snow R. W., Bastos de Azevedo I., Lowe B. S., Kabiru E. W., Nevill C. G., Mwankusye S., Kassiga G., Marsh K., Teuscher T. Severe childhood malaria in two areas of markedly different falciparum transmission in east Africa. Acta Trop. 1994 Sep;57(4):289–300. doi: 10.1016/0001-706x(94)90074-4. [DOI] [PubMed] [Google Scholar]
  22. Sáez-Llorens X., Vargas S., Guerra F., Coronado L. Application of new sepsis definitions to evaluate outcome of pediatric patients with severe systemic infections. Pediatr Infect Dis J. 1995 Jul;14(7):557–561. doi: 10.1097/00006454-199507000-00001. [DOI] [PubMed] [Google Scholar]
  23. Tamburlini G., Di Mario S., Maggi R. S., Vilarim J. N., Gove S. Evaluation of guidelines for emergency triage assessment and treatment in developing countries. Arch Dis Child. 1999 Dec;81(6):478–482. doi: 10.1136/adc.81.6.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Tibby S. M., Hatherill M., Murdoch I. A. Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients. Arch Dis Child. 1999 Feb;80(2):163–166. doi: 10.1136/adc.80.2.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Vega R. M., Avner J. R. A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children. Pediatr Emerg Care. 1997 Jun;13(3):179–182. doi: 10.1097/00006565-199706000-00001. [DOI] [PubMed] [Google Scholar]

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