Photo Credit: Pornpak Khunatorn

The following is a summary of “Evaluation of electronic measurement of capillary refill for Sepsis screening at ED triage,” published in the August 2023 issue of Emergency Medicine by Hansen et al.

To assess the correlation between capillary refill time (CRT) as measured by a medical device and the presence of sepsis in patients who arrive at the Emergency Department (ED). This prospective observational study recruited adult and pediatric patients during emergency department triage when the triage nurse considered sepsis a possible diagnosis. Patients were recruited at an academic healthcare facility from December 2020 to June 2022. The research assistant utilized an investigational medical device to assess the patient’s CRT. The results encompassed sepsis and septic shock as per the sep-3 criteria, septic shock characterized by the need for intravenous antibiotics and vasopressor support, admission to the intensive care unit, and mortality during hospitalization. Additional measures encompassed patient demographics and vital signs upon emergency department triage. 

Researchers conducted a univariate analysis to assess the associations between cardiac resynchronization therapy (CRT) and sepsis-related outcomes. A total of 563 patients were included in the study, out of which 48 fulfilled the Sep-3 criteria, 5 fulfilled the Sep-3 shock criteria, and 11 fulfilled the requirements for prior septic shock (administration of intravenous antibiotics and vasopressors to maintain a mean arterial pressure of 65). About 16 individuals were admitted to the Intensive Care Unit (ICU). The average age of the cohort was 49.1 years, with females accounting for 51%. The device assessed capillary refill time (CRT) showed a significant correlation with the diagnosis of sepsis according to the sep-3 criteria (odds ratio [OR] 1.23, 95% CI 1.06–1.43), septic shock according to the sep-3 criteria (OR 1.57, 95% CI 1.02–2.40), and septic shock defined as the administration of intravenous antibiotics and the need for vasopressors (OR 1.37, 95% CI 1.03–1.82). 

Patients with a CRT (capillary refill time) greater than 3.5 seconds, as measured by the DCR (digital capillary refill) device, exhibited an odds ratio of 4.67 (95% CI 1.31–16.1) for septic shock (according to the previous definition). Additionally, they had an odds ratio of 3.97 (95% confidence interval 1.99–7.92) for admission to the intensive care unit (ICU), which further supports the validity of using a 3.5-second cutoff for the DCR measurement. The measurement of capillary refill time (CRT) conducted by a medical device during the emergency department (ED) triage process was correlated with the sepsis diagnosis. Using a medical device to measure capillary refill time (CRT) could be a straightforward method to enhance sepsis diagnosis during emergency department (ED) triage.

Source: sciencedirect.com/science/article/abs/pii/S0735675723002528