Shinozaki Koichiro, Jacobson Lee S, Saeki Kota, Kobayashi Naoki, Weisner Steve, Falotico Julianne M, Li Timmy, Kim Junhwan, Lampe Joshua W, Becker Lance B
The Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, USA; Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA.
Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA.
Am J Emerg Med. 2021 Jun;44:284-290. doi: 10.1016/j.ajem.2020.04.007. Epub 2020 Apr 8.
Reliability of capillary refill time (CRT) has been questionable. The purpose of this study was to examine that a standardized method and clinical experience would improve the reliability of CRT.
This was a cross-sectional study in the emergency department (ED). Health care providers (HCPs) performed CRT without instruments (method 1) to classify patients as having normal or abnormal (≤2/>2 s) CRT. An ED attending physician quantitatively measured CRT using a chronograph (standardized visual CRT, method 2). A video camera was mounted on top of the hand tool to obtain a digital recording. The videos were used to calculate CRT via image software (image CRT, method 3) as a criterion standard of methods. Additionally, 9 HCPs reviewed the videos in a separate setting in order to visually assess CRT (video CRT, method 4).
We enrolled 30 patients in this study. Standardized visual CRT (method 2) identified 10 abnormal patients, while two patients were identified by CRT without instruments (method 1). There was no correlation (κ value, 0.00) between CRT without instruments (method 1) and image CRT (method 3), however the correlation between standardized visual CRT (method 2) and image CRT (method 3) was strong (r = 0.64, p < 0.01). Both intra-observer reliability and correlation coefficient with image CRT (method 3) was higher in video CRT (method 4) by more experienced clinicians.
Visual assessment is variable but a standardized method such as using a chronograph and/or clinical experience may aid clinicians to improve the reliability of visually assessed CRT.
毛细血管再充盈时间（CRT）的可靠性一直存疑。本研究旨在探讨标准化方法和临床经验能否提高CRT的可靠性。
这是一项在急诊科（ED）开展的横断面研究。医护人员（HCPs）不借助仪器进行CRT检查（方法1），以将患者分类为CRT正常或异常（≤2秒/>2秒）。急诊科主治医师使用计时秒表对CRT进行定量测量（标准化视觉CRT，方法2）。在手持工具顶部安装一台摄像机以获取数字记录。这些视频用于通过图像软件计算CRT（图像CRT，方法3），作为方法的标准参照。此外，9名医护人员在另一环境下观看这些视频，以便直观评估CRT（视频CRT，方法4）。
本研究共纳入30例患者。标准化视觉CRT（方法2）识别出10例异常患者，而不借助仪器的CRT（方法1）仅识别出2例。不借助仪器的CRT（方法1）与图像CRT（方法3）之间无相关性（κ值为0.00），然而标准化视觉CRT（方法2）与图像CRT（方法3）之间存在强相关性（r = 0.64，p < 0.01）。经验更丰富的临床医生采用视频CRT（方法4）时，观察者内部可靠性及与图像CRT（方法3）的相关系数均更高。
视觉评估存在差异，但诸如使用计时秒表之类的标准化方法和/或临床经验可能有助于临床医生提高视觉评估CRT的可靠性。
