The Diagnostic Value of Capillary Refill Time for Detecting Serious Illness in Children: A Systematic Review and Meta-Analysis
| Autor: | Fleming, Susannah, Gill, P, Jones, C, Taylor, JA, Van Den Bruel, A, Heneghan, Carl, Roberts, Nia, Thompson, M, Huy, NT |
|---|---|
| Přispěvatelé: | Huy, N |
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Fever MEDLINE lcsh:Medicine Severity of Illness Index Likelihood ratios in diagnostic testing 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Severity of illness medicine Humans 030212 general & internal medicine Child lcsh:Science Intensive care medicine Diagnostic Techniques and Procedures Multidisciplinary Dehydration medicine.diagnostic_test Receiver operating characteristic business.industry Mortality rate lcsh:R medicine.disease Capillary refill Capillaries 3. Good health Regional Blood Flow Meta-analysis Emergency medicine lcsh:Q business Meningitis Blood Flow Velocity Research Article |
| Zdroj: | PLoS ONE, Vol 10, Iss 9, p e0138155 (2015) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | © 2015 Fleming et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Importance: Capillary refill time (CRT) is widely recommended as part of the routine assessment of unwell children. Objective: To determine the diagnostic value of capillary refill time for a range of serious outcomes in children. Methods: We searched Medline, Embase and CINAHL from inception to June 2014. We included studies that measured both capillary refill time and a relevant clinical outcome such as mortality, dehydration, meningitis, or other serious illnesses in children aged up to 18 years of age. We screened 1,265 references, of which 24 papers were included in this review. Where sufficient studies were available, we conducted meta-analysis and constructed hierarchical summary ROC curves. Results: Meta-analysis on the relationship between capillary refill time and mortality resulted in sensitivity of 34.6%(95% CI 23.9 to 47.1%), specificity 92.3% (88.6 to 94.8%), positive likelihood ratio 4.49 (3.06 to 6.57), and negative likelihood ratio 0.71 (0.60 to 0.84). Studies of children attending Emergency Departments with vomiting and diarrhea showed that capillary refill time had specificity of 89 to 94% for identifying 5% dehydration, but sensitivity ranged from 0 to 94%. This level of heterogeneity precluded formal meta-analysis of this outcome. Meta-analysis was not possible for other outcomes due to insufficient data, but we found consistently high specificity for a range of outcomes including meningitis, sepsis, admission to hospital, hypoxia, severity of illness and dengue. Conclusions: Our results show that capillary refill time is a specific sign, indicating that it can be used as a "red-flag": children with prolonged capillary refill time have a four-fold risk of dying compared to children with normal capillary refill time. The low sensitivity means that a normal capillary refill time should not reassure clinicians. |
| Databáze: | OpenAIRE |
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