Does training level affect the accuracy of visual assessment of capillary refill time?

Shinozaki, Koichiro; Jacobson, Lee; Saeki, Kota; Kobayashi, Naoki; Weisner, Steve; Falotico, Julianne M.; Li, Timmy; Kim, Junhwan; Lampe, Joshua W.; Becker, Lance B.

doi:10.1186/s13054-019-2444-3

Cited by 23 publications

(26 citation statements)

References 5 publications

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“…The critical issue of the CRT measurement is the intra-observer difference [4]. Personal work experience and training have been suggested to possibly help improve the accuracy of CRT measurements [5]. Evidently, in the present study, the feedback function significantly reduced the intra-examiner variance.…”

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confidence: 50%

Feedback function for capillary refilling time measurement device

et al. 2019

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confidence: 50%

Feedback function for capillary refilling time measurement device

et al. 2019

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“…Lastly, standardized visual CRT used in our study has been recognized as a reliable measure but this is a subjective assessment of CRT. However, we consider this method appropriate for assessing peripheral perfusion status based on the following 3 reasons in terms of its validity and reliability: [1] there have been multiple previous works by other investigators that support the reliability of standardized visual CRT [1–3] [2]; we validated the reliability of our standardized visual CRT by using the other objective measurement, such as image analysis, and a strong correlation between these measures was found in our preliminary [16] [3]; our newly developed method, BRT, may wish to be validated by other objective measurements rather than compared with subjective standardized visual CRT, and therefore, we are currently working on another analysis evaluating BRT with CRT by image analysis.…”

Section: Discussionmentioning

confidence: 85%

“…A chronometer was used, which was the key to measuring reliable CRT. In addition, we recently reported that the training level of examiners positively impacts the accuracy and reliability of human visual assessment that is essential for measuring reliable CRT [16]. Therefore, in our study setting, the manual CRT was safely used as a study tool being compared with our novel BRT measurement.…”

Section: Discussionmentioning

confidence: 99%

Comparison of point-of-care peripheral perfusion assessment using pulse oximetry sensor with manual capillary refill time: clinical pilot study in the emergency department

Shinozaki

Jacobson

Saeki³

et al. 2019

j intensive care

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BackgroundTraditional capillary refill time (CRT) is a manual measurement that is commonly used by clinicians to identify deterioration in peripheral perfusion status. Our study compared a novel method of measuring peripheral perfusion using an investigational device with standardized visual CRT and tested the clinical usefulness of this investigational device, using an existing pulse oximetry sensor, in an emergency department (ED) setting.Material and methodsAn ED attending physician quantitatively measured CRT using a chronometer (standardized visual CRT). The pulse oximetry sensor was attached to the same hand. Values obtained using the device are referred to as blood refill time (BRT). These techniques were compared in its numbers with the Bland-Altman plot and the predictability of patients’ admissions.ResultsThirty ED patients were recruited. Mean CRT of ED patients was 1.9 ± 0.8 s, and there was a strong correlation with BRT (r = 0.723, p < 0.001). The Bland-Altman plot showed a proportional bias pattern. The ED physician identified 3 patients with abnormal CRT (> 3 s). Area under the receiver operator characteristic curve (AUC) of BRT to predict whether or not CRT was greater than 3 s was 0.82 (95% CI, 0.58–1.00). Intra-rater reliability of BRT was 0.88 (95% CI, 0.79–0.94) and that of CRT was 0.92 (0.85–0.96). Twelve patients were admitted to the hospital. AUC to predict patients’ admissions was 0.67 (95% CI, 0.46–0.87) by BRT and 0.76 (0.58–0.94) by CRT.ConclusionsBRT by a pulse oximetry sensor was an objective measurement as useful as the standardized CRT measured by the trained examiner with a chronometer at the bedside.

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“…Kawaguchi colleagues developed a device that can be adjusted for pressing strength and time using an electric actuator and strength and color sensors [27,28]. Shinozaki and colleagues used fingernail video recording and image analysis software for calculating CRT [29]. We developed a new device that can measure CRT quantitatively by using the pulse oximeter.…”

Section: Discussionmentioning

confidence: 99%

Pulse oximetry-based capillary refilling evaluation predicts postoperative outcomes in liver transplantation: a prospective observational cohort study

et al. 2020

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Background Capillary refill time (CRT) is a non-invasive technique to evaluate tissue perfusion, and quantitative CRT (Q-CRT) adapted to pulse oximetry was developed with patients with sepsis and compared to blood lactate and sepsis scores. In post liver transplantation, large amounts of fluid administration are necessary for maintaining tissue perfusion to grafted liver against intravascular hypovolemia. This study aimed to evaluate whether Q-CRT can predict poor outcomes by detecting peripheral tissue perfusion abnormality in patients with liver transplantations who were treated with massive fluid administration. Methods In this single-center prospective cohort study, we enrolled adult patients with liver transplantations between June 2018 and July 2019. Measurement of Q-CRT was conducted at intensive care units (ICU) admission and postoperative day 1 (POD1). Results A total of 33 patients with liver transplantations were enrolled. Significant correlations of Q-CRT and ΔAb, a tissue oxygen delivery parameter calculated by pulse oximetry data, at ICU admission with the postoperative outcomes such as length of ICU and hospital stay and total amount of ascitic fluid discharge were observed. Quantitative CRT and ΔAb at ICU admission were significantly associated with these postoperative outcomes, even after adjusting preoperative and operative factors (MELD score and bleeding volume, respectively). However, quantitative CRT and ΔAb at POD1 and changes from ICU admission to POD1 failed to show significant associations. Conclusions Q-CRT values were significantly associated with postoperative outcomes in liver transplantation. Although the mechanisms of this association need to be clarified further, Q-CRT may enable identification of high-risk patients that need intensive postoperative managements.

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Does training level affect the accuracy of visual assessment of capillary refill time?

Cited by 23 publications

References 5 publications

Feedback function for capillary refilling time measurement device

Feedback function for capillary refilling time measurement device

Comparison of point-of-care peripheral perfusion assessment using pulse oximetry sensor with manual capillary refill time: clinical pilot study in the emergency department

Pulse oximetry-based capillary refilling evaluation predicts postoperative outcomes in liver transplantation: a prospective observational cohort study

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