Capillary refill time (CRT) has been a widely utilized clinical parameter to assess peripheral perfusion and detect patient deterioration in the critical care setting. However, the accuracy of visual CRT assessment—and whether it’s influenced by the level of training clinicians have received—has long been a subject of debate. A recent study, highlighted in the journal Critical Care, offers new insights into this crucial clinical practice.
DOI: 10.1186/s13054-019-2444-3
In a research letter published on May 6, 2019, Shinozaki Koichiro and his team from The Feinstein Institute for Medical Research conducted a study investigating the influence of training level on the accuracy of CRT assessment. The findings could have substantial implications for patient care and medical training.
Background of the Study
CRT refers to the time taken for color to return to an external capillary bed after pressure is applied. It is a simple and non-invasive measure that can provide instant information about a patient’s circulatory status. Despite its common use for decades, the assessment of CRT is highly subjective, potentially leading to variability in the diagnosis and treatment of patients.
Understanding and Detecting CRT Accurately
The study conducted by Shinozaki et al. sought to evaluate whether a clinician’s experience could impact the ability to accurately assess CRT. The team measured CRT in critically ill patients, with varying levels of training among health professionals. The research aimed to ascertain if the accuracy of visually assessing CRT differed between seasoned doctors, nurses, and other less experienced medical staff.
Methodology
This study received ethical approval and informed consent from all patient participants, as noted by the Institutional Review Board (no. 17-0805). The research did not have significant financial support that could have influenced its outcome, maintaining the objectivity of the findings.
Critically ill patients were selected for the study, and CRT was measured by clinicians at different levels of training. Researchers then compared these visual assessments against quantitative measurements obtained through new medical technology designed to measure CRT with enhanced precision.
Results and Analysis
The study revealed significant variances in the accuracy of CRT assessments between clinicians with different levels of training. It was observed that more experienced clinicians were generally more accurate in their visual CRT estimations. However, it was also noted that training could improve the accuracy of CRT measurement across all levels of medical personnel.
Implications for Clinical Practice
These results suggest a pressing need for improved training in visual CRT assessment for all clinicians, regardless of their level of expertise. Hospitals and medical institutions must consider incorporating CRT assessment into regular training programs and continuous professional development sessions.
The study also highlights the potential benefit of introducing more quantitative measuring devices into clinical practice to support clinicians in making more accurate assessments of peripheral perfusion.
Limitations and Further Research
The study authors discern that more research is needed to determine the best methods of training and to validate quantitative CRT measurement devices in different clinical settings. The authors call for further investigation to develop standardized guidelines for CRT assessment.
Conclusion
This study underscores the importance of experience and training in the accurate assessment of CRT and recommends a blend of educational strategies and innovative technologies to enhance patient care. Hospitals should take note of these findings and consider integrating CRT measurement into their training protocols and clinical procedures.
References
1. Van Genderen ME, Paauwe J, de Jonge J, et al. Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults. Crit Care. 2014;18:R114. doi: 10.1186/cc13905.
2. Morimura N, Takahashi K, Doi T, et al. A pilot study of quantitative capillary refill time to identify high blood lactate levels in critically ill patients. Emerg Med J. 2015;32:444–448. doi: 10.1136/emermed-2013-203180.
3. Kawaguchi R, Nakada TA, Oshima T, et al. Optimal pressing strength and time for capillary refilling time. Crit Care. 2019;23:4. doi: 10.1186/s13054-018-2295-3.
4. Alsma J, van Saase JLCM, Nanayakkara PWB, et al. The power of flash mob research: conducting a nationwide observational clinical study on capillary refill time in a single day. Chest. 2017;151:1106–1113. doi: 10.1016/j.chest.2016.11.035.
5. Pickard A, Karlen W, Ansermino JM. Capillary refill time: is it still a useful clinical sign? Anesth Analg. 2011;113:120–123. doi: 10.1213/ANE.0b013e31821569f9.
Keywords
1. Capillary Refill Time
2. Critical Care Training
3. Clinical Assessment Accuracy
4. Peripheral Perfusion
5. Medical Training in CRT Assessment