Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs

Abstract

Purpose

No standardized execution or evidence demonstrates the area of the digit giving the most accurate capillary refill time (CRT). This study investigated the reliability and validity of CRT, and the relative merits of areas where the test could be performed.

Methods

In all, 127 healthy volunteers were assessed for normal CRT at the fingernail, lateral paronychia, and proximal and distal pulps of the index finger. The predictive validity of the CRT for the diagnosis of compromised vascular perfusion was also investigated on 24 subjects, using an inflated tourniquet. Three raters assessed interobserver reliability.

Results

The mean fingernail, lateral paronychia, proximal pulp, and distal pulp CRTs were 1.93, 1.78, 1.70, and 1.57 s, respectively. The tourniquet and non-tourniquet results demonstrated significant mean differences; however, the fingernail showed a subtle difference (1.22 s) compared with the proximal pulp (4.46 s). The CRT interobserver reliability was fair at the fingernail (intraclass correlation coefficient [ICC] = 0.51), but very poor in occluded limbs (ICC = 0.13). At the lateral paronychia and finger pulp, the interobserver reliability was reasonable (ICC = 0.75–0.81 [non-tourniquet] vs 0.62–0.68 [tourniquet]). In a receiver-operating characteristic curve analysis, the proximal pulp demonstrated better discrimination (area under the curve = 0.93, 95% CI 0.89–0.97, p  < 0.0001); the best cutoff point was calculated to be 3 s at the proximal pulp.

Conclusions

CRT use at appropriate areas is reliable. The most dependable site is the finger pulp, and the proposed cutoff is 3 s.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yuwarat Monteerarat and Torpon Vathana. The first draft of the manuscript was written by Yuwarat Monteerarat and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Torpon Vathana.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculty of Medicine Siriraj Hospital, Mahidol University (Date August 14, 2014 /No Si480/2014).

Consent to participate

Inform consent was obtained from all individual participants included in the study.

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Monteerarat, Y., Limthongthang, R., Laohaprasitiporn, P. et al. Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-020-01594-9

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Keywords

  • Capillary refill time
  • Cutoff point
  • Reliability
  • Finger pulp
  • Arterial occlusion