Capillary refill for the assessment of circulatory dysfunction in sepsis: A scoping review.

BACKGROUND

Sepsis remains a significant and difficult diagnosis in US Emergency Departments and Intensive Care Units.

OBJECTIVE

The objective of this scoping review was to understand the state of the literature regarding the performance of Capillary Refill Time [CRT] as a method to assess circulatory dysfunction in sepsis.

DESIGN

This study followed PRISMA Guidelines for Scoping Reviews. Included studies used CRT as a physical exam finding 'measuring the time of return of color to a blanched nailbed' and was limited to Emergency Department and Intensive Care Unit settings. Our search used OVID Medline from 1946 through December of 2022 and resulted in 800 articles that led to 13 being included in the final analysis. Included studies were appraised using the Newcastle Ottawa Score.

RESULTS

Overall, the strength of the evidence across the 13 final studies was moderate. Studies suffered from numerous methodological shortcomings, and reproducibility in how they measured capillary refill.

CONCLUSION

Capillary refill has the potential to assist in the assessment of circulatory dysfunction in sepsis; however, emerging technologies making bedside measurement more reproducible and reliable must be further developed and studied in prospective randomized control trials powered to predict meaningful patient outcomes.