Comparison of peripheral and central capillary refill time in febrile children presenting to a paediatric emergency department and its utility in identifying children with serious bacterial infection

Abstract

The pCRT and cCRT values showed only fair agreement in a general population of febrile children at the ED, and no significant association with age or body temperature was found. Only a small part of febrile children at risk for serious infections at the ED show abnormal CRT values. Both abnormal pCRT and cCRT (defined as >2 s) performed poorly and were non-significant in this study detecting SBI in a general population of febrile children.

Management of Children With Fever at Risk for Pediatric Sepsis: A Prospective Study in Pediatric Emergency Care

“…Furthermore, several studies discussed limitations of the interrater variability and interpretation of a prolonged capillary refill, often used in clinical sepsis scores (41,42). One study did not find an association between peripherally or centrally measured capillary refill and serious infections in the ED (43), contrasting with the often perceived usefulness of capillary refill as a reliable clinical sign of peripheral perfusion in the context of sepsis in high incidence clinical environments. Equally, altered mental state is a potential indicator of poor cerebral perfusion and this has been adopted as a warning sign in sepsis scores and guidelines.…”

Development and validation of machine learning-driven prediction model for serious bacterial infection among febrile children in emergency departments

“…Each clinical aspect from febrile children can be used to estimate the probability of SBI [ 3 ], from the peak or duration of fever, capillary refill time [ 4 ], well-known biochemical markers such as C reactive protein (CRP) and procalcitonin (PCT) [ 5 ], to some novel biomarkers that have been evaluated as candidates for predicting SBI [ 6 ]. Furthermore, ideas combining each of the parameters to improve the predictive performances have been examined.…”

Sepsis kills: suspect it, recognise it and be prompt with treatment

“…The ETAT update provides a hierarchical approach to the assessment of circulatory impairment using extremity temperature, CRT and pulse. Third, the new report from the Netherlands by de Vos-Kerkhof et al 2 provides us with more insight into the CRT. It should dispel the idea that it can be used in isolation, without reference to other clinical features, as a screening assessment for serious bacterial infection.…”

“…In December 2015, the National Medical Director of NHS-England wrote that sepsis care was ‘about ensuring that professionals are supported and equipped to be aware of sepsis, ensuring that they have access to evidence based guidelines, and that they are trained in identifying and treating sepsis promptly.’ (Notwithstanding, of course, the need for a clinical approach that adheres to good antibiotic stewardship.) Now, de Vos-Kerkhof et al 2 provide new information that helps with the recognition and identification aspect of this sepsis strategy—but, first, let us consider the context of two recent articles.…”

“…Now, in this issue, de Vos-Kerkhof et al 2 report a prospectively ascertained paediatric ED population in the Netherlands who presented with the history of recent fever at home, had fever in the ED or were categorised as febrile when first seen. In regards to improving recognition and identification of ‘serious bacterial infection’ (eg, pneumonia, meningitis and urinary tract infection), the authors have a number of important findings from their cohort of ∼1200 cases.…”