Capillary Refill

References

• Jacquet-Lagrèze M, Pernollet A, Kattan E, Ait-Oufella H, Chesnel D, Ruste M, Schweizer R, Allaouchiche B, Hernandez G, Fellahi JL. Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis. Crit Care. 2023;27(1):473. doi:10.1186/s13054-023-04751-9. PMID: 38042855. PMC10693708 (open access, BMC). PRISMA-compliant systematic review with bivariate random-effects meta-analysis following the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy; QUADAS-2 quality assessment; pre-registered on PROSPERO (CRD42022297158). 23 studies (60,656 patients) included overall; 13 studies in the primary analysis pool. Setting: emergency department (35%), ICU (43%), operating room (4%), prehospital (17%). 13 of 23 studies (57%) included only patients with acute circulatory failure; 11 of 23 (48%) included only septic shock. Mean abnormal CRT threshold across studies: 3.3 ± 0.8 seconds. Fingertip CRT in 78% of studies. Note: the PRIOR database citation incorrectly read 'Capillary refill time as a marker of perfusion in adult critically ill patients: a systematic review and meta-analysis. Ann Intensive Care. 2023;13(1):31' — that paper does NOT exist. The numerical values were correctly transcribed from this Jacquet-Lagrèze 2023 Crit Care paper but the citation metadata was wrong (different title, journal, volume, issue, page). Corrected in cascade #31 (11th citation/source-attribution issue caught in the Scope B audit).
• McGee S, Abernethy WB 3rd, Simel DL. The rational clinical examination. Is this patient hypovolemic? JAMA. 1999;281(11):1022-1029. doi:10.1001/jama.281.11.1022. PMID: 10086438. Free DARE summary at NCBI Bookshelf NBK67823.
• Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated? JAMA. 2004;291(22):2746-2754. doi:10.1001/jama.291.22.2746. PMID: 15187057. Full meta-analytic results freely available via DARE summary on NCBI Bookshelf (NBK70977). Underlying primary studies: 13 prospective diagnostic-accuracy studies (n=1,246 total children) of clinical examination findings for 5% dehydration; most enrolled hospitalized children with gastroenteritis-related dehydration; rehydration weight (weight gain following clinical rehydration) was the reference standard; random-effects pooling on log-LR.
• Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease? JAMA. 2006;295(5):536-546. doi:10.1001/jama.295.5.536. PMID: 16449619.
• McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.