scholarly journals Comparison of point-of-care peripheral perfusion assessment using pulse oximetry sensor with manual capillary refill time: clinical pilot study in the emergency department

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Koichiro Shinozaki ◽  
Lee S. Jacobson ◽  
Kota Saeki ◽  
Hideaki Hirahara ◽  
Naoki Kobayashi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pulse Oximetry ◽  
Point Of Care ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Capillary Refill Time ◽  
Peripheral Perfusion ◽  
Altman Plot ◽  
Capillary Refill ◽  
Bland Altman Plot

Abstract Background Traditional capillary refill time (CRT) is a manual measurement that is commonly used by clinicians to identify deterioration in peripheral perfusion status. Our study compared a novel method of measuring peripheral perfusion using an investigational device with standardized visual CRT and tested the clinical usefulness of this investigational device, using an existing pulse oximetry sensor, in an emergency department (ED) setting. Material and methods An ED attending physician quantitatively measured CRT using a chronometer (standardized visual CRT). The pulse oximetry sensor was attached to the same hand. Values obtained using the device are referred to as blood refill time (BRT). These techniques were compared in its numbers with the Bland-Altman plot and the predictability of patients’ admissions. Results Thirty ED patients were recruited. Mean CRT of ED patients was 1.9 ± 0.8 s, and there was a strong correlation with BRT (r = 0.723, p < 0.001). The Bland-Altman plot showed a proportional bias pattern. The ED physician identified 3 patients with abnormal CRT (> 3 s). Area under the receiver operator characteristic curve (AUC) of BRT to predict whether or not CRT was greater than 3 s was 0.82 (95% CI, 0.58–1.00). Intra-rater reliability of BRT was 0.88 (95% CI, 0.79–0.94) and that of CRT was 0.92 (0.85–0.96). Twelve patients were admitted to the hospital. AUC to predict patients’ admissions was 0.67 (95% CI, 0.46–0.87) by BRT and 0.76 (0.58–0.94) by CRT. Conclusions BRT by a pulse oximetry sensor was an objective measurement as useful as the standardized CRT measured by the trained examiner with a chronometer at the bedside.

scholarly journals Point-Of-Care Capillary Refill Technology Improves Accuracy of Peripheral Perfusion Assessment

2021 ◽  
Vol 8 ◽  
Author(s):  
David C. Sheridan ◽  
Robert L. Cloutier ◽  
Ravi Samatham ◽  
Matthew L. Hansen
Keyword(s):  
Emergency Department ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Great Promise ◽  
Care Hospital ◽  
Peripheral Perfusion ◽  
Large Variability ◽  
Capillary Refill ◽  
Research Personnel ◽  
Perfusion Assessment

Background: Peripheral perfusion assessment is used routinely at the bedside by measuring the capillary refill time (CRT). Recent clinical trials have shown evidence to its ability to recognize conditions with decreased end organ perfusion as well as guiding therapeutic interventions in sepsis. However, the current standard of physician assessment at the bedside has shown large variability. New technology can improve the precision and repeatability of CRT affecting translation of previous high impact research.Methods: This was a prospective, observational study in the intensive care unit and emergency department at a quaternary care hospital using a non-invasive finger sensor for CRT. The device CRT was compared to the gold standard of trained research personnel assessment of CRT as well as to providers clinically caring for the patient.Results: Pearson correlations coefficients were performed across 89 pairs of measurements. The Pearson correlation for the device CRT compared to research personnel CRT was 0.693. The Pearson correlation for the provider CRT compared to research personnel CRT was 0.359.Conclusions: New point-of-care technology shows great promise in the ability to improve peripheral perfusion assessment performed at the bedside in the emergency department triage and during active resuscitation. This standardized approach allows for better translation of prior research that is limited by the subjectivity of manual visual assessment of CRT.

scholarly journals Development and validation of an early warning tool for sepsis and decompensation in children during emergency department triage

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Louis Ehwerhemuepha ◽  
Theodore Heyming ◽  
Rachel Marano ◽  
Mary Jane Piroutek ◽  
Antonio C. Arrieta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Sepsis ◽  
Early Warning ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Warning System ◽  
Receiver Operator Characteristic Curve ◽  
Warning Signs ◽  
Gradient Boosting ◽  
Stochastic Gradient Boosting

AbstractThis study was designed to develop and validate an early warning system for sepsis based on a predictive model of critical decompensation. Data from the electronic medical records for 537,837 visits to a pediatric Emergency Department (ED) from March 2013 to December 2019 were collected. A multiclass stochastic gradient boosting model was built to identify early warning signs associated with death, severe sepsis, non-severe sepsis, and bacteremia. Model features included triage vital signs, previous diagnoses, medications, and healthcare utilizations within 6 months of the index ED visit. There were 483 patients who had severe sepsis and/or died, 1102 had non-severe sepsis, 1103 had positive bacteremia tests, and the remaining had none of the events. The most important predictors were age, heart rate, length of stay of previous hospitalizations, temperature, systolic blood pressure, and prior sepsis. The one-versus-all area under the receiver operator characteristic curve (AUROC) were 0.979 (0.967, 0.991), 0.990 (0.985, 0.995), 0.976 (0.972, 0.981), and 0.968 (0.962, 0.974) for death, severe sepsis, non-severe sepsis, and bacteremia without sepsis respectively. The multi-class macro average AUROC and area under the precision recall curve were 0.977 and 0.316 respectively. The study findings were used to develop an automated early warning decision tool for sepsis. Implementation of this model in pediatric EDs will allow sepsis-related critical decompensation to be predicted accurately after a few seconds of triage.

Comparison of peripheral and central capillary refill time in febrile children presenting to a paediatric emergency department and its utility in identifying children with serious bacterial infection

2016 ◽  
Vol 102 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Evelien de Vos-Kerkhof ◽  
Tarik Krecinic ◽  
Yvonne Vergouwe ◽  
Henriëtte A Moll ◽  
Ruud G Nijman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Body Temperature ◽  
General Population ◽  
Bacterial Infection ◽  
Capillary Refill Time ◽  
Radiographic Findings ◽  
Capillary Refill ◽  
Clinical Criteria ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

ObjectiveTo determine the agreement between peripheral and central capillary refill time (pCRT/cCRT) and their diagnostic values for detecting serious bacterial infection (SBI) in febrile children attending the paediatric emergency department (ED).DesignProspective observational study.SettingPaediatric ED, Erasmus Medium Care-Sophia Children's hospital, the Netherlands.Patients1193 consecutively included, previously healthy, febrile children (1 month–16 years) with both pCRT measurements and cCRT measurements available. SBI diagnosis was based on abnormal radiographic findings and/or positive cultures from normally sterile locations in addition to clinical criteria.Main outcome measuresAgreement between pCRT and cCRT (Cohen's κ), overall and stratified for age and body temperature. The diagnostic value of pCRT and cCRT for SBI was assessed with logistic regression.ResultsOverall agreement was 0.35 (95% CI 0.27 to 0.43; considered ‘fair’). Although not significant, agreement was lower in children aged 1–<5 years (κ: 0.15 (95% CI 0.04 to 0.27)) and decreased with higher body temperatures with κ ranging from 0.55 (95% CI 0.32 to 0.79) for temperature <37.5°C to 0.21 (95% CI 0.07 to 0.34) for temperature >39.5°C. Abnormal pCRT (>2 s) was observed in 153 (12.8%; 95% CI 10.9% to 14.7%) and abnormal cCRT in 55 (4.6%; 95% CI 3.4% to 5.8%) children. The OR of abnormal pCRT (>2 s) for predicting SBI was 1.10 (95% CI 0.65 to 1.84). For abnormal cCRT (>2 s), the OR was 0.43 (95% CI 0.13 to 1.39).ConclusionsThe pCRT and cCRT values showed only fair agreement in a general population of febrile children at the ED, and no significant association with age or body temperature was found. Only a small part of febrile children at risk for serious infections at the ED show abnormal CRT values. Both abnormal pCRT and cCRT (defined as >2 s) performed poorly and were non-significant in this study detecting SBI in a general population of febrile children.

Abstract 302: First of It's Kind Capillary Refill Monitoring Device to Guide Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
David C Sheridan
Keyword(s):  
Emergency Department ◽  
Light Transmission ◽  
New Technology ◽  
Tertiary Care ◽  
Prospective Trial ◽  
Care Hospital ◽  
Capillary Refill Time ◽  
Capillary Refill ◽  
Novel Technology ◽  
Innovation Approach

Background: Capillary refill is an early reflection of decreased end organ perfusion resulting in shunt of blood from the extremities to vital organs. Physicians rate this as the most important factor to guide therapeutic resuscitation efforts. However, literature shows that providers have significant variability in their bedside measurement of capillary refill. Objective: The objective of this study was to develop and evaluate a novel technology to detect capillary refill in a noninvasive and rapid manner through an iterative, problem-based innovation approach. Methods: This was a prospective study at a level 1 tertiary care hospital of patients presenting to an emergency department. The research team used in a new technology that utilizes light transmission and pressure to objectively quantify extremity capillary refill time. This measurement was compared to manual refill time performed by a trained study provider. Results: Through an iterative approach the team developed a platform technology and enrolled 63 subjects in this prospective trial. 9 subjects had inadequate data and so the final cohort consisted of 54 subjects with both manual capillary refill time and the new novel technology measurement. The device measured capillary refill time showed a high degree of correlation to manual estimate of capillary refill time with a Pearson coefficient of 0.7. Conclusions: Novel technology to measure capillary refill time can significantly improve the treatment and care of multiple medical conditions that rely on timely diagnosis and initiation of resuscitation in the emergency department and other care settings. This study shows a modest correlation of technology with automated signal processing algorithms for noninvasive measurement of capillary refill. Integration of this technology into standard hospital monitors has broad applicability to make capillary refill a standard vital sign.

scholarly journals Identifying High-Risk Children in the Emergency Department

2016 ◽  
Vol 31 (10) ◽  
pp. 660-666 ◽  
Author(s):  
Katie R. Nielsen ◽  
Russ Migita ◽  
Maneesh Batra ◽  
Jane L. Di Gennaro ◽  
Joan S. Roberts ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Characteristic Curve ◽  
Pediatric Intensive Care ◽  
Receiver Operator Characteristic Curve ◽  
Clinical Deterioration ◽  
Chi Square ◽  
Inpatient Ward ◽  
Increased Risk ◽  
Chi Square Analysis

Purpose: Early warning scores (EWS) identify high-risk hospitalized patients prior to clinical deterioration; however, their ability to identify high-risk pediatric patients in the emergency department (ED) has not been adequately evaluated. We sought to determine the association between modified pediatric EWS (MPEWS) in the ED and inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission. Methods: This is a case–control study of 597 pediatric ED patients admitted to the inpatient ward at Seattle Children’s Hospital between July 1, 2010, and December 31, 2011. Cases were children subsequently transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi-square analysis. Results: Fifty children experienced ward-to-PICU transfer within 24 hours of admission. The area under the receiver–operator characteristic curve was 0.691. Children with MPEWS > 7 in the ED were more likely to experience ward-to-PICU transfer (odds ratio 8.36, 95% confidence interval 2.98-22.08); however, the sensitivity was only 18.0% with a specificity of 97.4%. Using MPEWS >7 for direct PICU admission would have led to 167 unnecessary PICU admissions and identified only 9 of 50 patients who required PICU care. Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS threshold of 7 is not sufficient to identify more than a small proportion of ward-admitted children with subsequent clinical deterioration.

scholarly journals Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

2020 ◽  
Vol 7 ◽  
Author(s):  
Julianne M. Falotico ◽  
Koichiro Shinozaki ◽  
Kota Saeki ◽  
Lance B. Becker
Keyword(s):  
New Technologies ◽  
Clinical Care ◽  
Capillary Refill Time ◽  
Peripheral Perfusion ◽  
Capillary Refill ◽  
Sepsis Bundles ◽  
Advantages And Disadvantages ◽  
Hemodynamic Status ◽  
Life Saving ◽  
Resuscitation Guidelines

Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. By monitoring peripheral perfusion status, clinicians can promptly initiate life-saving therapy and reduce the likelihood of shock-associated death. Historically, abnormal perfusion has been indicated by the observation of pale, cold, and clammy skin with increased capillary refill time. The utility of these assessments has been debated given that clinicians may vary in their clinical interpretation of body temperature and refill time. Considering these constraints, current sepsis bundles suggest the need to revise resuscitation guidelines. New technologies have been developed to calculate capillary refill time in the hopes of identifying a new gold standard for clinical care. These devices measure either light reflected at the surface of the fingertip (reflected light), or light transmitted through the inside of the fingertip (transmitted light). These new technologies may enable clinicians to monitor peripheral perfusion status more accurately and may increase the potential for ubiquitous hemodynamic monitoring across different clinical settings. This review will summarize the different methods available for peripheral perfusion monitoring and will discuss the advantages and disadvantages of each approach.

Predictive Models for Very Preterm Birth: Developing a Point-of-Care Tool

2020 ◽  
Author(s):  
Courtney L. Hebert ◽  
Giovanni Nattino ◽  
Steven G. Gabbe ◽  
Patricia T. Gabbe ◽  
Jason Benedict ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Predictive Models ◽  
Goodness Of Fit ◽  
Point Of Care ◽  
Characteristic Curve ◽  
Preterm Births ◽  
First Trimester ◽  
Receiver Operator Characteristic Curve ◽  
Very Preterm ◽  
Very Preterm Birth

Objective The objective of this study was to create three point-of-care predictive models for very preterm birth using variables available at three different time points: prior to pregnancy, at the end of the first trimester, and mid-pregnancy. Study Design This is a retrospective cohort study of 359,396 Ohio Medicaid mothers from 2008 to 2015. The last baby for each mother was included in the final dataset. Births prior to 22 weeks were excluded. Multivariable logistic regression was used to create three models. These models were validated on a cohort that was set aside and not part of the model development. The main outcome measure was birth prior to 32 weeks. Results The final dataset contained 359,396 live births with 6,516 (1.81%) very preterm births. All models had excellent calibration. Goodness-of-fit tests suggested strong agreement between the probabilities estimated by the model and the actual outcome experience in the data. The mid-pregnancy model had acceptable discrimination with an area under the receiver operator characteristic curve of approximately 0.75 in both the developmental and validation datasets. Conclusion Using data from a large Ohio Medicaid cohort we developed point-of-care predictive models that could be used before pregnancy, after the first trimester, and in mid-pregnancy to estimate the probability of very preterm birth. Future work is needed to determine how the calculator could be used to target interventions to prevent very preterm birth. Key Points

Associations of β-hydroxybutyrate, cholesterol, triglycerides and high-density lipoproteins to non-esterified fatty acids pre- and postpartum

2016 ◽  
Vol 83 (4) ◽  
pp. 447-452
Author(s):  
Julia Ruoff ◽  
Sandra Bertulat ◽  
Onno Burfeind ◽  
Wolfgang Heuwieser
Keyword(s):  
Lipid Metabolism ◽  
Point Of Care ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
Receiver Operator Characteristic Curve ◽  
Human Medicine ◽  
High Density ◽  
High Density Lipoproteins ◽  
Nefa Concentration ◽  
Point Of Care Test

While laboratory tests for measuring the concentration of NEFA in serum are well established, a point of care test to determine NEFA on farm is not available. Several hand-held measuring devices, however, have been validated for measuring β-hydroxybutyrate (BHBA) in cattle or cholesterol, triglycerides (TAG), and high-density lipoproteins (HDL) in human medicine, respectively. The objective of this study was to evaluate the association between NEFA and different parameters related to lipid metabolism. Specifically, we set out to determine if it is feasible to predict the concentration of NEFA by means of surrogate measures. The concentration of BHBA was determined by a hand-held device evaluated for use in cows, whereas the concentrations of the other parameters were determined by laboratory analysis because hand-held devices for cholesterol, TAG and HDL are only evaluated for human medicine so far. A total of 254 cows were included in the trial. One blood sample was taken from each cow between d 10 and d 1 prepartum. Second and third samples were collected on d 2 and d 10 postpartum, respectively. The coefficients of correlation between parameters were calculated and a receiver-operator characteristic curve analysis has been used. The prediction of NEFA concentrations using only one of the parameters was insufficient. However, a NEFA concentration ≥0·5 mEq/l could be predicted with a high sensitivity (i.e. Se = 0·88) and specificity (i.e. Sp = 0·93) from d 3 to d 1 prepartum and a NEFA concentration ≥0·7 mEq/l could be reliably predicted on d 2 postpartum (i.e. AUC = 0·89, Se = 0·89, Sp = 0·76) when using a combination of BHBA, cholesterol and TAG as surrogates. Overall, our results suggest that a combination of different parameters of lipid metabolism could be used as surrogates for NEFA.

Digital Axillary and Non-Contact Infrared Thermometers for Children

2016 ◽  
Vol 27 (2) ◽  
pp. 180-190 ◽  
Author(s):  
Ilaria Franconi ◽  
Carmen La Cerra ◽  
Anna Rita Marucci ◽  
Cristina Petrucci ◽  
Loreto Lancia
Keyword(s):  
Emergency Department ◽  
Body Temperature ◽  
Observational Study ◽  
Temperature Measurement ◽  
Pediatric Emergency ◽  
Mean Difference ◽  
Pediatric Emergency Department ◽  
Altman Plot ◽  
Bland Altman Plot ◽  
Body Temperature Measurement

Axillary digital thermometers (ADTs) and non-contact (infrared) forehead thermometers (NCIFTs) are commonly used in pediatric settings, where an incorrect body temperature measurement may delay treatments or lead to incorrect diagnoses and therapies. Several studies comparing ADT or NCIFT with other methods have found conflicting results. To investigate whether ADT and NCIFT can be used interchangeably, a comparative observational study was conducted involving 205 children aged 0 to 14 years who were consecutively admitted to the pediatric emergency department. The Bland–Altman plot illustrated agreement between the two methods. A total of 217 pairs of measurements were compared; axillary measurements showed average values significantly higher than forehead measurements (37.52°C and 37.12°C; t = 7.42, p = .000), with a mean difference of 0.41°C between the two methods (range = −1.80 and +2.40). In this setting and population, ADT and NCIFT cannot be used interchangeably.

scholarly journals Improving Linkage to Care of Hepatitis C: Clinical Validation of GeneXpert® HCV Viral Load Point-of-Care Assay in Indonesia

2021 ◽  
Author(s):  
Meta Dewi Thedja ◽  
Dhita Prabasari Wibowo ◽  
Korri Elvanita El-Khobar ◽  
Susan Irawati Ie ◽  
Turyadi ◽  
...  
Keyword(s):  
Viral Load ◽  
Hepatitis C ◽  
Point Of Care ◽  
Pearson Correlation ◽  
Diagnosis And Treatment ◽  
Altman Plot ◽  
Modular Systems ◽  
Bland Altman Plot ◽  
Plot Analysis ◽  
Deming Regression

Hepatitis C virus (HCV) infection large-scale diagnosis and treatment are hampered by lack of a simple, rapid, and reliable point-of-care (POC) test, which poses a challenge for the elimination of hepatitis C as a public health problem. This study aimed to evaluate Cepheid Xpert® HCV Viral Load performance in comparison with the Roche Cobas® TaqMan® HCV Test using serum samples of HCV-infected patients in Indonesia. Viral load quantification was performed on 243 anti-HCV positive patients’ samples using both Xpert HCV VL and Roche HCV tests, followed by HCV genotyping by reverse hybridization. Strength of the relationship between the assays was measured by Pearson correlation coefficient, while level of agreement was analyzed by Deming regression and Bland–Altman plot analysis using log10-transformed viral load values. Quantifiable viral load was detected in 180/243 (74.1%), with Xpert HCV VL sensitivity of 100% (95% CI 0.98, 1.00) and specificity of 98.4% (95% CI 0.91, 0.99) based on Roche HCV tests, while HCV genotypes were determined in 172/180 (95.6%) samples. There was a good correlation between both assays (r = 0.97, P < 0.001), overall and per genotype, with good concordance by Deming regression and a mean difference of −0.25 log10 IU/mL (95% CI −0.33, −0.18) by Bland–Altman plot analysis. Xpert HCV VL test was demonstrated as a POC platform with good performance for HCV diagnosis and treatment decision that would be beneficial for decentralized service in resource-limited areas. HCV testing sites, alongside additional GeneXpert modular systems distributed toward the fight against COVID-19, could ensure some continuity, once this pandemic is controlled.

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