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Capillary refill time: a study of interobserver reliability among nurses and nurse assistants

Brabrand, Mikkela; Hosbond, Susanneb; Folkestad, Larsa

European Journal of Emergency Medicine: February 2011 - Volume 18 - Issue 1 - p 46–49
doi: 10.1097/MEJ.0b013e32833b4fba

Objectives The interobserver variability of capillary refill time (CRT) has been questioned. Earlier studies of interobserver variability of CRT have been on a large number of patients but with few observers. The objective of our study was to investigate how a large group of nurses and nurse assistants would grade CRT.

Methods We recorded a video of the index finger of six medical patients and these were shown to nurses and nurse assistants. They were asked to record the CRT and whether they found this value to be normal. The data were analyzed using the Fleiss Kappa Coefficient Analysis and graded according to the Landis and Koch correlation. Correlation between the exact numbers was evaluated using interclass correlation.

Results Nine nurse assistants and 37 nurses participated. The patients were aged between 44 and 87 years. All but one patient had a systolic blood pressure reading above 130 mmHg. All had arterial blood oxygen saturation above 92% and all but one had normal body temperature. The κ value for normality was 0.56. The interclass correlation of measurement of CRT was 0.62.

Conclusion This is the largest interobserver study of CRT when looking at the number of observers. We found an only moderate agreement for the exact value of CRT and a moderate agreement for normality. We believe that CRT should be used with caution in clinical practice.

aDepartment of Medicine, Sydvestjysk Sygehus, Esbjerg

bDepartment of Cardiology, Odense University Hospital, Odense, Denmark

Correspondence to Mikkel Brabrand, MD, Department of Medicine, Sydvestjysk Sygehus Esbjerg, Finsensgade 35DK-6700 Esbjerg, Denmark Tel: +45 79 18 22 48; fax: +45 79 18 22 66; e-mail:

Received January 8, 2010

Accepted April 22, 2010

© 2011 Lippincott Williams & Wilkins, Inc.