The Research Question Systematic review of the diagnostic accuracy of capillary refill time for serious illness in children S Fleming, P Gill, C Jones, A Van den Bruel, J Taylor, C Heneghan, M Thompson How good is capillary refill time (CRT) as a diagnostic indicator of serious illness in children? Why this is important? Simple and quick test requiring no equipment Easily performed on every child Widely recommended, but no existing systematic review BP34 Adherence to Antibiotic Prescribing for LRTI and Association With Recovery (Oral Presentation On Completed Research) Nick Francis, MD, PhD, Cardiff University; David Gillespie; Jacqueline Nuttall; Paul Little; Theo Verheij; Samuel Coenen; Jochen Cals; Kerenza Hood; Herman Goossens; Christopher Butler

What the Researchers Did Design: Systematic review of diagnostic accuracy 3 databases, not restricted by language or geography Inclusion Criteria CRT measured on at least 20 children (<18 years) Relationship between CRT and relevant clinical outcome Quality assessment using criteria based on QUADAS-2 checklist Search strategy identified 23 relevant papers 9 papers on mortality 6 papers on dehydration 10 papers on other serious outcomes aged ≥18 years, consulting with an illness where an acute or worsened cough was the main or dominant symptom, or had a clinical presentation that suggested a lower respiratory tract infection that had been present for ≥28 days.

What the Researchers Found Mortality CRT is highly specific, but has low sensitivity Specificity 92.3% (95%CI 88.6 to 94.8%) Data predominantly from low income settings Dehydration and other serious outcomes Prolonged CRT consistently increases the post-test probability of serious outcomes Normal CRT does not noticeably reduce the probability of adverse outcomes

What This Means for Clinical Practice CRT has value as a “red flag” for a wide variety of serious illnesses in children In low-income settings, there is evidence for CRT as a “red-flag” for risk of mortality Clinicians treating children with prolonged (≥3s) CRT should consider the possibility of serious illness