Contribution of Capillary Refilling Time and Skin Mottling Score to Predict ICU Admission of Patients with Septic or haemorrhagic Shock Admitted to the Emergency Department: A TRCMARBSAU Study [Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Ahead of Print: TARD-28459 | DOI: 10.5152/TJAR.2019.28459  

Contribution of Capillary Refilling Time and Skin Mottling Score to Predict ICU Admission of Patients with Septic or haemorrhagic Shock Admitted to the Emergency Department: A TRCMARBSAU Study

Romain Jouffroy1, Emmanuel Bloch-laine2, Maxime Maignan3, Pierrick Le Borgne4, Nicolas Marjanovic5, Thomas Lafon6, Scarlett Dehdar7, Lea Thomas8, Pierre Michelet9, Benoit Vivien1
1Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
2Department of Emergency, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
3Department of Emergency and SAMU, Grenoble Alps University Hospital, Grenoble; Department of Emergency, Hautepierre Hospital, University Hospital of Strasbourg, Strasbourg, France
4INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France
5Department of Emergency and SAMU, Poitiers University Hospital, Poitiers, France
6Department of Emergency, SAMU, Inserm CIC 1435, Limoges University Hospital Center, Limoges, France
7Department of Emergency, Argenteuil Hospital, Argenteuil, France
8Department of Emergency, Begin Military Hospital, Clamart, France
9Department of Emergency, Timone Hospital, Aix-Marseille University – CV2N, INSERM, INRA, Assistance Publique Hôpitaux de Marseille, Marseille, France

Objective: In the emergency department (ED), the severity assessment of shock is a fundamental step prior to the admission in the intensive care unit (ICU). As biomarkers are time consuming to evaluate the severity of micro- and macro-circulation alteration, capillary refill time and skin mottling score are two simple, available clinical criteria validated to predict mortality in the ICU. The aim of the present study is to provide clinical evidence that capillary refill time and skin mottling score assessed in the ED also predict ICU admission of patients with septic or haemorrhagic shock.

Methods: This trial is an observational, non-randomised controlled study. A total of 1500 patients admitted to the ED for septic or haemorrhagic shock will be enrolled into the study. The primary outcome is the admission to the ICU.

Results: The study will not impact the treatments provided to each patient. Capillary refill time and skin mottling score will not be taken into account to decide patient’s treatments and/or ICU admission. Patients will be followed up during their hospital stay to determine their precise destination after the ED (home, ICU or ward) and the 28- and 90-day mortality after hospital admission.

Conclusion: The results from the present study will provide clinical evidence on the correlation between the ICU admission and the capillary refill time and the skin mottling score in septic or haemorrhagic shock admitted to the ED. The aim of the present study is to provide two simple, reliable and non-invasive tools for the triage and early orientation of these patients.

Keywords: Capillary refill time, emergency, intensive care unit, prediction, skin mottling score




Corresponding Author: Romain Jouffroy, France


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