Relationship between Capillary Refill Time at Triage and Abnormal Clinical Condition: A Prospective Study
Claudia M. Sansone1, Fabiano Prendin2, Greta Giordano3, Paola Casati4, Anne Destrebecq5, Stefano Terzoni6, *
1 Nurse, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Corso Mazzini 18, 28100 Novara, Italy
2 Nurse, Emergency Department, San Paolo teaching hospital, Via A. di Rudinì, 8 – 20142 Milan, Italy
3 Nurse, ASST Santi Paolo e Carlo, presidio San Paolo, Via A. di Rudinì, 8 – 20142 Milan, Italy
4 Operating theatre, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
5 Associate professor of Nursing, University of Milan, Via Ovada, 26 – 20142 Milan, Italy
6 PhD, Tutor Nurse, San Paolo bachelor school of Nursing, San Paolo teaching hospital, Via Ovada, 26 – 20142 Milan, Italy
Capillary refill time has been studied in literature as a perfusion indicator. Two pilot studies have proposed possible reference values in healthy adults. No data exist regarding capillary refill time as an indicator of abnormal clinical conditions in adults, which might be of help for triage nurses.
We wanted to assess if any relationships existed, between altered capillary refill time and abnormal clinical conditions in the emergency department. We investigated relations between capillary refill time and vital signs recorded in triage and blood tests, by analyzing the clinical records. Mortality at 24 hours, 7 days and over 14 days was investigated by calling the patients after discharge.
Observational, single-center study on a sample of consecutive patients aged ≥ 18 years in the Emergency Department of a major Milan hospital, from June to October 2014. Multivariate logistic regression was used to investigate the impact of clinical variables on capillary refill time.
1001 patients were enrolled, aged 59 ± 21 (473 aged 65 or more). Longer refill times were found in patients admitted to hospital units after medical consultations in the emergency department compared to those discharged or sent to outpatients. In elderly patients, statistically significant association was found between increased capillary refill time and sepsis (sensitivity 100%, specificity 83.33%, area under the receiver operating characteristics curve 65.95% CI 47-83), oxygen saturation, mean blood pressure, and lactates. In persons aged 45 to 64, altered refill times were associated with abnormal values of glicemia, platelets, and urea.
Capillary refill time can be used by nurses at triage as a complementary parameter to normal vital signs. This is one of the few studies investigating refill time in adult patients.
Keywords: Assessment, Capillary refill time, Clinical conditions, Nursing, Perfusion, Triage.
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* Address correspondence to this authors at the San Paolo bachelor school of Nursing, San Paolo teaching hospital, Via Ovada, 26 – 20142 Milan, Italy; Tel: +39 02 8184 4038; Fax: +39 02 8184 4297; E-mail: email@example.com