1. 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

2. 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.

3. 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

4. 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