title: 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: OBJECTIVE
  To determine the agreement between peripheral and central capillary refill time (pCRT/cCRT) and their diagnostic values for detecting serious bacterial infection (SBI) in febrile children attending the paediatric emergency department (ED).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Paediatric ED, Erasmus Medium Care-Sophia Children's hospital, the Netherlands.
  
  
  METHODS
  1193 consecutively included, previously healthy, febrile children (1 month-16 years) with both pCRT measurements and cCRT measurements available. SBI diagnosis was based on abnormal radiographic findings and/or positive cultures from normally sterile locations in addition to clinical criteria.
  
  
  METHODS
  Agreement between pCRT and cCRT (Cohen's κ), overall and stratified for age and body temperature. The diagnostic value of pCRT and cCRT for SBI was assessed with logistic regression.
  
  
  RESULTS
  Overall agreement was 0.35 (95% CI 0.27 to 0.43; considered 'fair'). Although not significant, agreement was lower in children aged 1-<5 years (κ: 0.15 (95% CI 0.04 to 0.27)) and decreased with higher body temperatures with κ ranging from 0.55 (95% CI 0.32 to 0.79) for temperature <37.5°C to 0.21 (95% CI 0.07 to 0.34) for temperature >39.5°C. Abnormal pCRT (>2 s) was observed in 153 (12.8%; 95% CI 10.9% to 14.7%) and abnormal cCRT in 55 (4.6%; 95% CI 3.4% to 5.8%) children. The OR of abnormal pCRT (>2 s) for predicting SBI was 1.10 (95% CI 0.65 to 1.84). For abnormal cCRT (>2 s), the OR was 0.43 (95% CI 0.13 to 1.39).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: de Vos-Kerkhof
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Tarik
authors.initials: T
authors.lastname: Krecinic
authors.affiliation: Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Vergouwe
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Ruud G
authors.initials: RG
authors.lastname: Nijman
authors.affiliation: Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Rianne
authors.initials: R
authors.lastname: Oostenbrink
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis* / Q000503:physiopathology; D002196:Capillaries / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D005334:Fever / Q000382:microbiology* / Q000503:physiopathology; D005385:Fingers / Q000098:blood supply; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013249:Sternum / Q000098:blood supply
keywords: Accident & Emergency; Circulatory; General Paediatrics; Infectious Diseases; Measurement