Quantitative capillary refill time predicts sepsis in patients with suspected infection in the emergency department: an observational study

Oi, Yasufumi; Morimura, Naoto; Shirasawa, Aya; Honzawa, Hiroshi; Oyama, Yutaro; Niida, Shoko; Abe, Takeru; Imaki, Shouhei; Takeuchi, Ichiro

doi:10.1186/s40560-019-0382-4

Cited by 21 publications

(13 citation statements)

References 24 publications

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“…One recent publication detailed a new technology that can obtain capillary refill using a different optic method than traditional transmitted pulse oximetry with improved accuracy, but further clinical trials are needed. 29 In 2019, Yasufumi et al 30 repurposed a pulse oximeter to quantitatively measure CRTs. The subject places their finger inside the device, which exerts pressure to stop blood flow temporarily, then releases and measures the transmitted light utilizing existing pulse oximetry optic sensor technology.…”

Section: Resultsmentioning

confidence: 99%

Recent Advances in Bedside Device-Based Early Detection of Sepsis

Somogyi

Sheridan

2021

J Intensive Care Med

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Early detection of sepsis is challenging to achieve with current diagnostic methods, leading to expenditures of $27 billion annually in the United States with significant associated mortality. Various scoring systems have been proposed such as the sequential organ failure assessment (SOFA) and systemic inflammatory response syndrome (SIRS) criteria for identification of sepsis, but their sensitivities range from 60% to 70% when used in the emergency department triage. Other methods for the recognition of sepsis may rely on laboratory work, in addition to vitals monitoring, and are often outpaced by the development of sepsis. Automated alerts have not shown any reduction in mortality thus far. New technology may fill a critical gap in the early detection of sepsis. The ideal bedside screening device for would demonstrate rapid time to result, high portability, and high sensitivity to not miss cases, but also reasonable specificity to prevent provider fatigue from excessive false alerts. Non-invasive end-organ perfusion devices analyzing lactate and capillary refill time (CRT) tend to perform well in speed and portability, but may be less sensitive. Biomarker devices demonstrate a wider array of performance metrics. Those analyzing a single biomarker tend to be more sensitive but are less specific to the diagnosis of sepsis than technologies that assess multiple biomarkers, which in turn have lower sensitivity. Additionally, biomarker devices are generally invasive requiring blood samples, which may or may not be feasible in all patients especially when serial draws are needed. Sepsis is a complex disease process and most likely will require a combination of improved technology in addition to vital signs and high-risk patient history for better recognition. This review examines recent advances in the device-based early detection of sepsis between 2017 and 2020 with emphasis on bedside diagnostics, divided into markers of perfusion and biomarkers commonly implicated in sepsis.

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Section: Resultsmentioning

confidence: 99%

Recent Advances in Bedside Device-Based Early Detection of Sepsis

Somogyi

Sheridan

2021

J Intensive Care Med

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“…Although it did not reach statistical significance ( p = 0.06), when utilizing a pragmatic Bayesian analysis CRT was superior ( 8 ). A more recent study evaluated objective CRT measurement through a transmitted pulse oximetry light source and were able to show it significantly improved the test characteristics of standard sepsis screening scores in the ED ( 9 ). This type of technology has great promise for ED triage where studies have shown the ability to accurately triage sepsis patients can have significant impact on outcomes ( 10 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

Point-Of-Care Capillary Refill Technology Improves Accuracy of Peripheral Perfusion Assessment

et al. 2021

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Background: Peripheral perfusion assessment is used routinely at the bedside by measuring the capillary refill time (CRT). Recent clinical trials have shown evidence to its ability to recognize conditions with decreased end organ perfusion as well as guiding therapeutic interventions in sepsis. However, the current standard of physician assessment at the bedside has shown large variability. New technology can improve the precision and repeatability of CRT affecting translation of previous high impact research.Methods: This was a prospective, observational study in the intensive care unit and emergency department at a quaternary care hospital using a non-invasive finger sensor for CRT. The device CRT was compared to the gold standard of trained research personnel assessment of CRT as well as to providers clinically caring for the patient.Results: Pearson correlations coefficients were performed across 89 pairs of measurements. The Pearson correlation for the device CRT compared to research personnel CRT was 0.693. The Pearson correlation for the provider CRT compared to research personnel CRT was 0.359.Conclusions: New point-of-care technology shows great promise in the ability to improve peripheral perfusion assessment performed at the bedside in the emergency department triage and during active resuscitation. This standardized approach allows for better translation of prior research that is limited by the subjectivity of manual visual assessment of CRT.

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“…Together, these results suggest that Q-CRT might be an effective measure of insufficient global tissue perfusion and shock in both the ICU and ED. In ED patients with suspected infection, Yasufumi et al ( 38 ) investigated the ability of Q-CRT to predict sepsis compared with quick sequential organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) scores. The authors reported that the accuracy of Q-CRT in predicting sepsis was comparable to qSOFA scores, SIRS scores, and lactate level.…”

Section: Methods To Monitor Peripheral Perfusionmentioning

confidence: 99%

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

et al. 2020

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Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. By monitoring peripheral perfusion status, clinicians can promptly initiate life-saving therapy and reduce the likelihood of shock-associated death. Historically, abnormal perfusion has been indicated by the observation of pale, cold, and clammy skin with increased capillary refill time. The utility of these assessments has been debated given that clinicians may vary in their clinical interpretation of body temperature and refill time. Considering these constraints, current sepsis bundles suggest the need to revise resuscitation guidelines. New technologies have been developed to calculate capillary refill time in the hopes of identifying a new gold standard for clinical care. These devices measure either light reflected at the surface of the fingertip (reflected light), or light transmitted through the inside of the fingertip (transmitted light). These new technologies may enable clinicians to monitor peripheral perfusion status more accurately and may increase the potential for ubiquitous hemodynamic monitoring across different clinical settings. This review will summarize the different methods available for peripheral perfusion monitoring and will discuss the advantages and disadvantages of each approach.

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Quantitative capillary refill time predicts sepsis in patients with suspected infection in the emergency department: an observational study

Cited by 21 publications

References 24 publications

Recent Advances in Bedside Device-Based Early Detection of Sepsis

Recent Advances in Bedside Device-Based Early Detection of Sepsis

Point-Of-Care Capillary Refill Technology Improves Accuracy of Peripheral Perfusion Assessment

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

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