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Capillary refill time and serious bacterial infection
The assessment of febrile children is challenging in the acute setting where many children present with fever and the detection and treatment of serious bacterial infection is a key priority. Abnormal capillary refill time is considered to be a warning sign for serious bacterial infection. de Vos-Kerkhof and colleagues report data determining the agreement between peripheral (pCRT) and central (cCRT) capillary refill time and their diagnostic values for detecting serious bacterial infection in children attending the emergency department (n=1193, age 1 month to 16 years). Serious bacterial infection was present in 11.8%—abnormal radiology/positive cultures. Abnormal pCRT (>2s) was observed in 12.8%, and abnormal cCRT in 4.6%. Neither were good predictors for serious bacterial infection; abnormal pCRT OR 1.10 (95% confidence interval 0.65 to 1.84), abnormal cCRT OR 0.43 (95% confidence interval 0.13 to 1.39). The authors conclude that the diagnostic value of pCRT or cCRT for the detection of serious bacterial infection in this cohort was poor. These findings are important and relevant to clinicians. There is an excellent accompanying editorial in which this and other recent data is discussed—Sepis kills: suspect it, recognise it and be prompt with treatment. See pages 17 and 2
Recent developments in the detection and management of acute kidney injury
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