Article Text

Download PDFPDF
Capillary refill: prognostic value in Kenyan children
  1. A Pamba1,
  2. K Maitland2
  1. 1Centre for Geographic Medicine Research, Coast, KEMRI/Wellcome Trust Unit, PO Box 230, Kilifi, Kenya
  2. 2Department of Academic Paediatrics, Imperial College, London, UK
  1. Correspondence to:
    Dr K Maitland
    KEMRI/Wellcome Trust Unit, PO Box 230, Kilifi, Kenya; kmaitland{at}


Aims: To determine whether delayed capillary refill time (>3 seconds) is a useful prognostic indicator in Kenyan children admitted to hospital.

Methods: A total of 4160 children admitted to Kilifi District Hospital with malaria, malarial anaemia, acute respiratory tract infection (ARI), severe anaemia (haemoglobin <50 g/l), gastroenteritis, malnutrition, meningitis, or septicaemia were studied.

Results: Overall, delayed capillary refill time (dCRT), present in 346/4160 (8%) of the children, was significantly more common in fatal cases (44/189, 23%) than survivors (7.5%), and had useful prognostic value. In children admitted with malaria, gastroenteritis, or malnutrition, likelihood ratio tests suggested that dCRT was useful in identifying high risk groups for mortality, but its prognostic value in anaemia, ARI, and sepsis was unclear due to low case fatality or limited numbers. The severity features of impaired consciousness and deep breathing were significantly associated both with the presence of dCRT and fatal outcome. In children, with either of these severity features, a less stringent value of dCRT(>2 s) identified 50% of children with hypotension (systolic BP <2SD) and 40% of those requiring volume resuscitation (for metabolic acidosis).

Conclusions: Although CRT is a simple bedside test, which may be used in resource poor settings as a guide to the circulatory status, dCRT should not be relied on in the absence of other features of severity. In non-severe disease, the additional presence of hypoxia, a moderately raised creatinine (>80 μmol/l), or a raised white cell count should prompt the need for fluid expansion.

  • ARI, acute respiratory tract infection
  • BP, blood pressure
  • CRT, capillary refill time
  • dCRT, delayed capillary refill time (>3 seconds)
  • CVP, central venous pressure
  • GE, gastroenteritis
  • Hb, haemoglobin
  • HDU, high dependency unit
  • KDH, Kilifi District Hospital
  • LR, likelihood ratio
  • MA, malaria anaemia
  • NCHS, National Child Health Surveillance
  • SD, standard deviation
  • SS, severity sign
  • WBC, white cell count
  • WHO, World Health Organisation
  • capillary refill
  • Africa
  • children
  • triage
  • malaria
  • malnutrition

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Atoms
    Howard Bauchner