Can we trust naked eye assessments of the capillary refill test in children? An experimental study.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Frida Meyer, Jonatan Stahre, Joakim Henricson, Daniel B Wilhelms
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引用次数: 0

Abstract

Background: The capillary refill test is widely used in pediatric emergency medicine and critical care although its validity and reliability are debated. Naked eye estimation is the recommended method for capillary refill time (CR time) assessment. The goal of this study was to compare naked eye estimations of the CR time in pediatric patients to quantified capillary refill time (qCR time) using polarized reflectance imaging as an objective reference, and to investigate interobserver and intra-observer consistency of naked eye assessments of CR time.

Method: A film sequence comprising videos of capillary refill tests from 15 emergency pediatric patients was shown under standardized conditions to 62 observers (pediatricians, nurses, assistant nurses, and medical secretaries). The observers' estimations of CR time in seconds and in descriptive categorizations were compared to objectively derived qCR time. Three tests were shown twice without the observers' knowledge.

Results: There was poor interobserver agreement in all professions, with limits of agreement ranging from 1.17 s (assistant nurses) to 2.00 s (secretaries). Intra-observer agreement for estimations of both time and descriptive categorizations was limited. The correlation between naked eye assessments and qCR time was weak.

Conclusion: This study shows that naked eye assessment of CR time in children is highly subjective with poor reproducibility in pediatric nurses and pediatricians, as well as in comparison to a quantitative method. Based on the lack of both inter- and intra-observer consistency in the assessments, these findings suggest that CR time assessed by naked eye should be questioned as a routine test in pediatric emergencies.

儿童毛细血管再充盈试验的肉眼评估可信吗?一项实验研究。
背景:毛细管再灌注试验广泛应用于儿科急诊和重症监护,但其效度和信度存在争议。肉眼估计是评估毛细血管再充盈时间(CR时间)的推荐方法。本研究的目的是比较使用偏振反射成像作为客观参考的儿科患者的肉眼估计的CR时间与量化的毛细血管再充盈时间(qCR时间),并探讨观察者之间和观察者内部肉眼评估CR时间的一致性。方法:在标准化条件下,将15例儿科急诊患者的毛细血管再充血试验录像序列播放给62名观察者(儿科医生、护士、助理护士和医务秘书)。观察者对以秒为单位和描述性分类的CR时间的估计与客观衍生的qCR时间进行比较。三个测试在观察者不知情的情况下播放了两次。结果:所有职业的观察者之间的一致性较差,一致性范围为1.17 s(助理护士)至2.00 s(秘书)。观察员内部对时间和描述性分类估计的一致意见是有限的。裸眼评价与qCR时间相关性较弱。结论:本研究表明,与定量方法相比,小儿护士和儿科医生对儿童CR时间的裸眼评估主观性强,可重复性差。基于评估缺乏观察者之间和观察者内部的一致性,这些发现表明,肉眼评估的CR时间作为儿科急诊的常规测试应该受到质疑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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