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American Academy of Pediatrics
Article

A Novel Imaging Technique to Measure Capillary-Refill Time: Improving Diagnostic Accuracy for Dehydration in Young Children With Gastroenteritis

Itai Shavit, Rollin Brant, Cheri Nijssen-Jordan, Roger Galbraith and David W. Johnson
Pediatrics December 2006, 118 (6) 2402-2408; DOI: https://doi.org/10.1542/peds.2006-1108
Itai Shavit
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Rollin Brant
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Cheri Nijssen-Jordan
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Roger Galbraith
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David W. Johnson
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Abstract

BACKGROUND. Assessment of dehydration in young children currently depends on clinical judgment, which is relatively inaccurate. By using digital videography, we developed a way to assess capillary-refill time more objectively.

OBJECTIVE. Our goal was to determine whether digitally measured capillary-refill time assesses the presence of significant dehydration (≥5%) in young children with gastroenteritis more accurately than conventional capillary refill and overall clinical assessment.

METHODS. We prospectively enrolled children with gastroenteritis,1 month to 5 years of age, who were evaluated in a tertiary-care pediatric emergency department and judged by a triage nurse to be at least mildly dehydrated. Before any treatment, we measured the weight and digitally measured capillary-refill time of these children. Pediatric emergency physicians determined capillary-refill time by using conventional methods and degree of dehydration by overall clinical assessment by using a 7-point Likert scale. Postillness weight gain was used to estimate fluid deficit; beginning 48 hours after assessment, children were reweighed every 24 hours until 2 sequential weights differed by no more than 2%. We compared the accuracy of digitally measured capillary-refill time with conventional capillary refill and overall clinical assessment by determining sensitivities, specificities, likelihood ratios, and area under the receiver operator characteristic curves.

RESULTS. A total of 83 patients were enrolled and had complete follow-up; 13 of these patients had significant dehydration (≥5% of body weight). The area under the receiver operator characteristic curves for digitally measured capillary-refill time and overall clinical assessment relative to fluid deficit (<5% vs ≥5%) were 0.99 and 0.88, respectively. Positive likelihood ratios were 11.7 for digitally measured capillary-refill time, 4.5 for conventional capillary refill, and 4.1 for overall clinical assessment.

CONCLUSIONS. Results of this prospective cohort study suggest that digitally measured capillary-refill time more accurately predicts significant dehydration (≥5%) in young children with gastroenteritis than overall clinical assessment.

  • preschool child
  • gastroenteritis
  • dehydration
  • diagnostic techniques and procedures
  • sensitivity and specificity
  • Accepted August 30, 2006.
  • Copyright © 2006 by the American Academy of Pediatrics

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Pediatrics
Vol. 118, Issue 6
December 2006
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A Novel Imaging Technique to Measure Capillary-Refill Time: Improving Diagnostic Accuracy for Dehydration in Young Children With Gastroenteritis
Itai Shavit, Rollin Brant, Cheri Nijssen-Jordan, Roger Galbraith, David W. Johnson
Pediatrics Dec 2006, 118 (6) 2402-2408; DOI: 10.1542/peds.2006-1108

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A Novel Imaging Technique to Measure Capillary-Refill Time: Improving Diagnostic Accuracy for Dehydration in Young Children With Gastroenteritis
Itai Shavit, Rollin Brant, Cheri Nijssen-Jordan, Roger Galbraith, David W. Johnson
Pediatrics Dec 2006, 118 (6) 2402-2408; DOI: 10.1542/peds.2006-1108
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