Capillary refill time test

admin · Nov 14, 2006

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An evaluation of the reliability and validity of capillary refill time test

Nerida L. Klupp, and Anne-Maree Keenan
The Foot; Available online 7 November 2006.

Background
While capillary refill time test (CRTT) has been commonly used as a quick and convenient clinical vascular assessment of the lower limb, the validity of this test has not been established.
Objectives
There were three aims to this study: the first was to evaluate the reliability of CRTT, the second to investigate the premise that CRTT represents skin perfusion, and thirdly to determine whether CRTT can detect lower limb vascular disease.

Method
Intra- and inter-tester reliability was evaluated for five experienced physicians who used CRTT on 10 participants. Criterion validity for measurement of skin perfusion was investigated by comparison with laser Doppler flowmetry on 49 participants, and for this same group the usefulness of detecting those persons with peripheral arterial disease and a state of impaired healing was evaluated.

Results
CRTT had reasonable intra-tester reliability (ICC = 0.72) but poorer inter-tester reliability (ICC range = 0.12–0.81). For measurement of skin perfusion, CRTT was predictive of only 38% of the variance in laser Doppler flowmetry measures (r2 = 0.38, P < 0.001). Finally, CRTT was not able to discriminate between patients with and without peripheral arterial disease (z = −1.86, P = 0.062), nor could it discern between patients with and without impaired lower extremity healing (z = −0.21, P = 0.830). Laser Doppler flowmetry was also unable to predict the presence of peripheral arterial disease (t96 = 0.27, P = 0.787) and impaired healing (t96 = 1.95, P = 0.054).

Conclusion
These results question the usefulness of capillary refill time test for assessment of vascular status in the lower limb.
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NewsBot · Sep 28, 2014

Validity and reliability of measurement of capillary refill time in children: a systematic review.
Fleming S, Gill P, Jones C, Taylor JA, Van den Bruel A, Heneghan C, Thompson M.
Arch Dis Child. 2014 Sep 26

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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