A multidisciplinary survey on capillary refill time: Inconsistent performance and interpretation of a common clinical test.
OBJECTIVE
Capillary refill time is a common clinical test used in pediatric critical care and emergency medicine. Despite this, we hypothesize that capillary refill time is performed inconsistently and its interpretation by healthcare providers in the acute care setting is variable.


METHODS
Multidisciplinary survey.


METHODS
Canadian tertiary care pediatric hospital.


METHODS
Subjects were 198 pediatric healthcare providers.


METHODS
A self-administered questionnaire survey was sent to healthcare providers in pediatric and neonatal critical care, emergency medicine, and cardiology.


RESULTS
Seventy-eight surveys were returned: 23 of 33 pediatric trainees (70%), 22 of 38 staff physicians (58%), and 33 of 125 nurses (26%). Ninety-five percent of pediatric healthcare providers reported performing capillary refill time on most patients. However, while 90% of nurses and 70% of trainees described performing capillary refill time on every patient, only 18% of staff physicians reported performing capillary refill time routinely on every patient. Although all participants responded that a capillary refill time of >3 secs was abnormal, responders were divided on the definition of normal capillary refill time. While other sites were described, responders most commonly reported performing capillary refill time on a patient's chest. Ninety-six percent of responders agreed that prolonged capillary refill time indicates abnormal perfusion.


CONCLUSIONS
The results of this single-institution survey show that while most nurses and pediatric trainees reported using capillary refill time on every patient as a test for perfusion, only a few staff physicians reported using capillary refill time on every patient. In addition, although this study shows that the majority of survey responders stated that they used capillary refill time frequently, we observed no consistent response in how they performed and interpreted capillary refill time. Given that the use of this simple, noninvasive clinical test is supported by many pediatric organizations and pediatricians, the results of this study emphasize the need to examine why this test is inconsistently performed by healthcare providers so as to ensure its reliable performance in the future.
Lobos
Anna-Theresa
AT
Department of Pediatrics, University of Ottawa, Department of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. alobos@cheo.on.ca
Menon
Kusum
K
D002170:Canada; D002196:Capillaries / Q000503:physiopathology; D002675:Child, Preschool; D019937:Diagnostic Techniques and Procedures; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008833:Microcirculation; D009726:Nurses; D010372:Pediatrics; D011787:Quality of Health Care