Clinical Predictors of Capillary Refill Time and Their Association With Triage Categories

NCT07054151 | Completed

• 1 other identifier: IzmirDemocracy
• Study Type: observational
• Target: 313
• Locations: 1 country
• Sites: 1

Brief Summary

This observational study aims to determine the correlation between capillary refill time (CRT) and vital parameters in patients presenting to the emergency department. It explores whether CRT is associated with triage categories and vital signs in non-traumatic patients, including oxygen saturation (SpO₂), heart rate, systolic and diastolic blood pressure, body temperature, forearm temperature, and respiratory rate. Patients admitted to the emergency department of a training and research hospital were assigned triage codes (green, yellow, red). Their CRT was measured three times, and vital signs were recorded accordingly.

Conditions

Triage; Emergency Medical Services; Vital Signs Monitoring; Hypoperfusion; Hemodynamic Instability

Keywords

Vital parameters; capillary refill time; prediction; Non-trauma Emergency; Emergency Medical Services; Triage; clinical decision-making

Outcome Measures

Primary Outcomes (9)

• Triage Code Assignment

  Triage code assignment will be completed within the first 30 minutes of the patient's initial presentation to the emergency department (ED). Patients will be categorized into green, yellow, or red triage groups based on standard emergency triage protocols upon admission. Following this, the patient will be transferred to the designated emergency care room (ER) based on the assigned triage code and further clinical evaluation and treatment. Initially, the triage nurse will assess the patient and assign the triage code. Following this, the patient will be transferred to the designated emergency care room (ER), where a specialist emergency physician will perform further clinical evaluation and treatment.

  Baseline [within 30 minutes of initial Emergency department admission triage assessment]

• Capillary Refill Time (CRT) in Seconds

  CRT will be measured in seconds using a stopwatch after pressing the fingertip. The measurement will be repeated three times and average was calculated.Triage code assignment will be completed within the first 30 minutes of the patient's initial presentation to the emergency department (ED). Following this, the patient will be transferred to the designated emergency care room (ER) based on the assigned triage code, and all vital parameters (e.g., capillary refill time, heart rate, blood pressure) will be measured within 10 minutes of entering the emergency care area.

  Single measurement by the emergency physician within 10 minutes of the patient's arrival in the emergency care room

• Heart Rate

  Heart rate will be recorded using standard clinical devices. Unit: Beats per minute Measurement technique:: Measured using clinical monitor.. Upon the patient's initial presentation to the emergency department (ED), triage code assignment will be completed within the first 30 minutes. Based on the assigned code, the patient will be directed to the appropriate emergency care room (ER). Heart rate measurements will be taken within 10 minutes of the patient's arrival in the emergency care room.

  The patient is then assessed by the emergency physician within 10 minutes of being transferred to the ER triage code section. (Single measurement )

• Systolic Blood Pressure

  systolic blood pressure will be recorded using standard clinical devices. Unit: mmHg Measurement technique: Measured using clinical monitor. Upon the patient's initial presentation to the emergency department (ED), triage code assignment will be completed within the first 30 minutes. Based on the assigned triage code, the patient will be directed to the appropriate emergency care room (ER). Systolic blood pressure will be measured once, within 10 minutes of the patient's arrival in the emergency care room. Systolic and diastolic blood pressure will be measured simultaneously in a single session within 10 minutes of the patient's arrival in the emergency care room.

  Single simultaneous measurement (systolic and diastolic) by the emergency physician within 10 minutes of arrival in the emergency care room (ER).

• Diastolic Blood Pressure

  diastolic blood pressure will be recorded using standard clinical devices. Unit: mmHg Measurement technique: Measured using clinical monitor. Upon the patient's initial presentation to the emergency department (ED), triage code assignment will be completed within 30 minutes. Based on the assigned triage code, the patient will be transferred to the appropriate emergency care room (ER). Diastolic and systolic blood pressure will be measured simultaneously in a single session within 10 minutes of the patient's arrival in the emergency care room.

  Single simultaneous measurement (systolic and diastolic) by the emergency physician within 10 minutes of arrival in the emergency care room (ER).

• SpO2 (Oxygen Saturation)

  SpO2 will be recorded using standard clinical devices. Unit: Percent (%) Measurement technique: Measured using pulse oximetry. Oxygen saturation (SpO₂), along with other vital signs (blood pressure, heart rate), will be measured in a single session within 10 minutes of the patient's arrival in the emergency care room.

  Single measurement by the emergency physician within 10 minutes of the patient's arrival in the emergency care room

• Respiratory Rate

  respiratory rate will be recorded using standard clinical devices. Unit: Breaths per minute Measurement technique: Measured using observation and counting.

  Following the patient's admission to the ER, the triage nurse determins the patient's triage code. The patient is then assessed by the emergency physician within 10 minutes of being transferred to the ER triage code section. (single timepoint)

• Forearm Temperature

  Forearm temperature will be recorded using standard clinical devices. Unit: Degrees Celsius Measurement technique: Measured using infrared thermometer.

  Single measurement by the emergency physician within 10 minutes of the patient's arrival in the emergency care room (ER).

• Body Temperature

  Body temperature will be recorded using standard clinical devices. Unit: Degrees Celsius. Body temperature was measured with a Yobekan model KV-11 infrared measuring device. Measurement technique: Measured using infrared thermometer. All vital signs, including body temperature, were assessed sequentially by the same emergency physician within 10 minutes after the patient was transferred to the emergency care room (ER).

  Single measurement by the emergency physician within 10 minutes of the patient's arrival in the emergency care room (ER).

Secondary Outcomes (2)

• Correlation Between Capillary Refill Time and Age

  During the study period through data collection and data entry, expected to be completed within an average of 3 months.

• Association Between Prolonged CRT (>2s) and Triage Category

  During the study period through data collection and data entry, expected to be completed within an average of 3 months.

Study Arms (1)

Non-traumatic patients admitted to the emergency department of Izmir Democracy University Buca Seyfi

Other: No clinical intervention (observational study only)

Interventions

No clinical intervention (observational study only) OTHER

This is an observational study. No experimental or clinical intervention was applied. Only non-invasive data collection such as capillary refill time and vital sign measurements was performed.

Non-traumatic patients admitted to the emergency department of Izmir Democracy University Buca Seyfi

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population consists of non-trauma patients who applied to the emergency department of Buca Research and Training Hospital.

You may qualify if:

• individuals over the age of 18 years who consented to participate in the study

You may not qualify if:

• The presence of pregnancy
• Multiple traumas resulting in hypovolemia
• The absence of fingers or limbs
• The utilization of vasopressors or inotropic pharmacological agents
• The existence of peripheral arterial disease
• The presence of nail polish or fake nails

Sponsors & Collaborators

• Izmir Democracy University: lead

Study Sites (1)

Buca Training and Research Hospital, Emergency Deaprtment

Izmir, Turkey (Türkiye)

Location

Related Publications (18)

• Adhikari S. Available at: www.jgpeman.com, eISSN: 2363-1168 28 SHORT REVIEW: CAPILLARY REFILLL VS SERUM LACTATE IN SEPTIC. Vol. 7, SHOCK Journal of General Practice and Emergency Medicine of Nepal. 2018.

  BACKGROUND

• Sheridan DC, Kohn-Loncarica GA, Nunez P, Hudson R, Lin A, Samatham R, Hansen ML. Point-of-Care Noninvasive Technology for Pediatric Dehydration Assessment. Pediatr Emerg Care. 2023 Aug 1;39(8):569-573. doi: 10.1097/PEC.0000000000002824. Epub 2022 Oct 10.

  PMID: 36252055 BACKGROUND

• Baker AH, Mazandi VM, Norton JS, Melendez E. Emergency Department Sepsis Triage Scoring Tool Elements Associated With Hypotension Within 24 Hours in Children With Fever and Tachycardia. Pediatr Emerg Care. 2024 Sep 1;40(9):644-649. doi: 10.1097/PEC.0000000000003153. Epub 2024 Mar 13.

  PMID: 38471759 BACKGROUND

• Sheridan DC, Cloutier R, Kibler A, Hansen ML. Cutting-Edge Technology for Rapid Bedside Assessment of Capillary Refill Time for Early Diagnosis and Resuscitation of Sepsis. Front Med (Lausanne). 2020 Dec 21;7:612303. doi: 10.3389/fmed.2020.612303. eCollection 2020.

  PMID: 33425956 BACKGROUND

• Jacquet-Lagreze M, Bouhamri N, Portran P, Schweizer R, Baudin F, Lilot M, Fornier W, Fellahi JL. Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion. Crit Care. 2019 Aug 16;23(1):281. doi: 10.1186/s13054-019-2560-0.

  PMID: 31420052 BACKGROUND

• Ait-Oufella H, Bige N, Boelle PY, Pichereau C, Alves M, Bertinchamp R, Baudel JL, Galbois A, Maury E, Guidet B. Capillary refill time exploration during septic shock. Intensive Care Med. 2014 Jul;40(7):958-64. doi: 10.1007/s00134-014-3326-4. Epub 2014 May 9.

  PMID: 24811942 BACKGROUND

• Faul A, Lang. Correlation Problems Referring to One Correlation Comparison of a correlation with a constant 0 (bivariate normal model) Comparison of a correlation with 0 (point biserial model) Comparison of a correlation with a constant 0 (tetrachoric correlation model).

  BACKGROUND

• Sansone CM, Prendin F, Giordano G, Casati P, Destrebecq A, Terzoni S. Relationship between Capillary Refill Time at Triage and Abnormal Clinical Condition: A Prospective Study. Open Nurs J. 2017 Jul 26;11:84-90. doi: 10.2174/1874434601711010084. eCollection 2017.

  PMID: 28839512 BACKGROUND

• Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med. 1988 Sep;17(9):932-5. doi: 10.1016/s0196-0644(88)80675-9.

  PMID: 3415066 BACKGROUND

• Jacquet-Lagreze M, Wiart C, Schweizer R, Didier L, Ruste M, Coutrot M, Legrand M, Baudin F, Javouhey E, Depret F, Fellahi JL. Capillary refill time for the management of acute circulatory failure: a survey among pediatric and adult intensivists. BMC Emerg Med. 2022 Jul 18;22(1):131. doi: 10.1186/s12873-022-00681-x.

  PMID: 35850662 BACKGROUND

• Lewin J, Maconochie I. Capillary refill time in adults. Emerg Med J. 2008 Jun;25(6):325-6. doi: 10.1136/emj.2007.055244. No abstract available.

  PMID: 18499809 BACKGROUND

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  BACKGROUND

• Van der Mullen J, Wise R, Vermeulen G, Moonen PJ, Malbrain MLNG. Assessment of hypovolaemia in the critically ill. Anaesthesiol Intensive Ther. 2018;50(2):141-149. doi: 10.5603/AIT.a2017.0077. Epub 2017 Nov 28.

  PMID: 29182211 BACKGROUND

• McGuire D, Gotlib A, King J. Capillary Refill Time. 2023 Apr 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK557753/

  PMID: 32491685 BACKGROUND

• Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS, Prall RH. Assessment of injury severity: the triage index. Crit Care Med. 1980 Apr;8(4):201-8. doi: 10.1097/00003246-198004000-00001.

  PMID: 7357873 BACKGROUND

• Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med. 1981 Sep;9(9):672-6. doi: 10.1097/00003246-198109000-00015.

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• BEECHER HK, SIMEONE FA, et al. The internal state of the severely wounded man on entry to the most forward hospital. Surgery. 1947 Oct;22(4):672-711. No abstract available.

  PMID: 20266131 BACKGROUND

• Pickard A, Karlen W, Ansermino JM. Capillary refill time: is it still a useful clinical sign? Anesth Analg. 2011 Jul;113(1):120-3. doi: 10.1213/ANE.0b013e31821569f9. Epub 2011 Apr 25.

  PMID: 21519051 BACKGROUND

Related Links

• DataSet

Study Officials

• Aysel Başer, Assoc.Prof.

  Izmir Democracy University, Medical Faculty

  STUDY DIRECTOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assoc. Prof.

Study Record Dates

• First Submitted: May 21, 2025
• First Posted: July 8, 2025
• Study Start: July 1, 2024
• Primary Completion: September 30, 2024
• Study Completion: September 30, 2024
• Last Updated: July 8, 2025

Record last verified: 2025-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: ICF, ANALYTIC CODE
• Time Frame: IPD and supporting document can be available between 01 September 2025 - 31 August 2028
• Access Criteria: Access to the IPD will be granted to qualified researchers affiliated with academic or research institutions, upon submitting a research proposal that is approved by an independent ethics committee

Locations

TU (1)