Written by Andy Hogan
Spoon Feed
Prolonged central capillary refill time is associated with increased mortality in adult trauma patients – including those with “stable” initial vital signs.
A pale sternum should concern ‘em
This retrospective observational study was a secondary analysis of 19,054 adult (>16 y/o) trauma patients from the CRASH-2 study. It investigated whether central capillary refill time (CRT), assessed over the sternum during initial patient assessment, was associated with 28-day mortality in this cohort. CRT was divided into 3 categories: ≤2 s, 3-4 s, or ≥5 s. Compared to the ‘normal’ reference (≤2 s), CRTs of 3-4 s (OR 1.7) and ≥5 s (OR 3.2) were associated with significantly increased odds of 28-day mortality. Notably, these associations persisted for patients (n=15,977) without initial signs of shock (HR <100 bpm, systolic BP >90 mmHg) and remained true on sensitivity analysis using a modified ‘normal’ CRT of ≤3 s. CRT values >2 s were also significantly associated with higher odds of requiring blood transfusion or surgical intervention.
The study’s main limitations arise from being a secondary analysis. A mortality endpoint of 28 days was used due to availability from the CRASH-2 data set, though the direct impact of data from this distant time point on acute trauma management is less clear. Furthermore, serial CRT values were not obtained, so the utility of this tool for assessing trends could not be examined.
How does this change my practice?
Based on these results, detecting a delayed CRT during the initial trauma exam could identify patients who merit more aggressive management, especially those who present without vital sign derangements. CRT is a technically simple, quick, and inexpensive technique that can easily be incorporated into the standard trauma exam.
Source
Association of central capillary refill time with mortality in adult trauma patients: a secondary analysis of the crash-2 randomised controlled trial data. Scand J Trauma Resusc Emerg Med. 2025 May 12;33(1):82. doi: 10.1186/s13049-025-01407-1. PMID: 40355927
