58-Video-Based Capillary Refill Time Assessment in Children
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Pediatrics, Procedures, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Ryan B. Hunter


Introduction/Hypothesis: Capillary refill time (CRT) is used to assess peripheral perfusion in children with suspected shock. Interclinician CRT assessment is reported as inconsistent. During pandemics remote video-based CRT (VBCRT) assessment may be warranted but is untested. We hypothesized the correlation of standardized bedside CRT and VBCRT would be high and VBCRT across raters would be consistent.

Methods: 99 children (1-12yr) had 10 consecutive bedside CRT measurements by an experienced critical care clinician. CRT measurement was standardized with 5s of firm compression and video recorded in a replicable fashion with optimal hand position in the camera window on a black background. 30 patient clips were prospectively selected: 10 flash (<1s), 10 normal (1-2s), and 10 prolonged (>2s). 10 pediatric critical care attending physicians received identical scripted instructions and reviewed 30 clips twice in randomized order on a 43in screen under identical lighting conditions. To ensure accurate recording of perceived CRT, raters were instructed to push a button when finger compression was released and again when finger color fully returned to baseline (CRT). The correlation and absolute difference between bedside and VBCRT were assessed by Pearson's correlation and paired t-test. Consistency across raters and repeated measures within each rater were analyzed using the intraclass correlation coefficient (ICC) and for absolute agreement using the Generalizability (G) study.

Results: 10 raters (practice years including fellowship: Mdn 11.5yr, IQR 9-14) reviewed 30 clips twice. Moderate agreement was observed between the bedside CRT and VBCRT (r=0.65, p<0.001). VBCRT was assessed as shorter by 0.17s (95% CI: 0.09-0.25, p<0.001) compared to bedside CRT. Among the video rating of each clip, the largest source of variance was patient (57%), followed by patient-rater interaction (11%). The consistency across raters over 30 clips x 2 measurements was ICC=0.58. Within each rater, the two measurements on the same video clip yielded good consistency: ICC=0.73. Overall G coefficient was 0.57.

Conclusions: Bedside and video assessment of CRT correlated with a statistically significant offset of 0.17s. Across raters, CRT measurement showed moderate consistency while repeated measurements within each rater were highly consistent.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Procedures
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Monitoring
Year 2021
capillary refill time
video-based assessments
variation in measurements


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