Capillary Refill Time and Oxygen Saturation as Predictors of Patient Acuity in Emergency Severity Index Triage: A Cross-Sectional Study
Abstract
Background. Rapid physiological assessment in emergency departments (EDs) is essential for accurate triage and timely intervention. The Emergency Severity Index system categorises patients by clinical urgency, yet evidence remains limited regarding the prognostic value of capillary refill time and peripheral oxygen saturation in identifying high-acuity cases.
Aim. To examine the relationship between capillary refill time, peripheral oxygen saturation, and patient acuity levels based on Emergency Severity Index triage categories.
Methods. This analytical cross-sectional study evaluated medical records of 80 adult patients treated at a pulmonary hospital ED. Capillary refill time, peripheral oxygen saturation, and Emergency Severity Index levels were extracted. Associations were analysed using the Chi-Square test, with statistical significance set at p < 0.05. Prevalence ratios and 95% confidence intervals were calculated.
Results. Prolonged capillary refill time exceeding two seconds was significantly associated with higher-acuity Emergency Severity Index levels 1–2 (p < 0.001; prevalence ratio = 19.2; 95% confidence interval: 5.4–68.2). Similarly, peripheral oxygen saturation below 90 percent correlated with higher acuity (p < 0.001; prevalence ratio = 19.9; 95% confidence interval: 4.0–97.8).
Conclusions. Capillary refill time and peripheral oxygen saturation are strong physiological predictors of patient acuity in Emergency Severity Index triage. Incorporating these measures into triage protocols may enhance the early identification of critically ill patients, particularly in resource-limited emergency settings.
Keywords: capillary refill time; oxygen saturation; triage; Emergency Severity Index; patient acuity
References
Akyıl, F. T., & Yıldırım, S. (2019). The clinical significance and age analysis of patients admitted to emergency department with chest diseases. Southern Clinics of Istanbul Eurasia, 30(4), 320–325. https://doi.org/10.14744/scie.2019.70883 DOI: https://doi.org/10.14744/scie.2019.70883
Ariyani, H., & Rosidawati, I. (2020). Literature review: Penggunaan triase Emergency Severity Index (ESI) di instalasi gawat darurat (IGD). Jurnal Kesehatan Bakti Tunas Husada: Jurnal Ilmu-Ilmu Keperawatan, Analis Kesehatan dan Farmasi, 20(2), 143–152. https://doi.org/10.36465/jkbth.v20i2.606 DOI: https://doi.org/10.36465/jkbth.v20i2.606
Bazmul, M. F., Lantang, E. Y., & Kambey, B. I. (2019). Profil kegawatdaruratan pasien berdasarkan Start Triage Scale di instalasi gawat darurat RSUP Prof. Dr. R. D. Kandou Manado periode Januari 2018 sampai Juli 2018. Jurnal E-Clinic (ECl), 7(1), 46–50. https://doi.org/10.35790/ecl.v7i1.23538 DOI: https://doi.org/10.35790/ecl.7.1.2019.23538
Daş, M., Bardakci, O., Siddikoglu, D., Akdur, G., Yilmaz, M. C., Akdur, O., & Beyazit, Y. (2020). Prognostic performance of peripheral perfusion index and shock index combined with ESI to predict hospital outcome. American Journal of Emergency Medicine, 38(10), 2055–2059. https://doi.org/10.1016/j.ajem.2020.06.084 DOI: https://doi.org/10.1016/j.ajem.2020.06.084
Emergency Nurses Association. (2023). Emergency severity index handbook (5th ed.).
Fernández-Sarmiento, J., Lamprea, S., Barrera, S., Acevedo, L., Duque, C., Trujillo, M., Aguirre, V., & Jimenez, C. (2024). The association between prolonged capillary refill time and microcirculation changes in children with sepsis. BMC Pediatrics, 24(68), 1–10. https://doi.org/10.1186/s12887-024-04524-5 DOI: https://doi.org/10.1186/s12887-024-04524-5
Hania, U. P., Budiharto, I., & Yulanda, N. A. (2020). Literature review: Faktor-faktor yang mempengaruhi response time perawat pada penanganan IGD. Pro Ners, 5(2), 1–14. https://doi.org/10.1007/springerreference_23659 DOI: https://doi.org/10.1007/SpringerReference_23659
Kikomeko, B., Mutiibwa, G., Nabatanzi, P., Lumala, A., & Kellett, J. (2022). A prospective, internal validation of an emergency patient triage tool for use in a low resource setting. African Journal of Emergency Medicine, 12(3), 287–292. https://doi.org/10.1016/j.afjem.2022.05.003 DOI: https://doi.org/10.1016/j.afjem.2022.05.003
Kobayashi, M., Fukuda, S., Takano, K. I., Kamizono, J., & Ichikawa, K. (2018). Can a pulse oxygen saturation of 95% to 96% help predict further vital sign destabilization in school-aged children? Medicine, 97(25), 1–5. https://doi.org/10.1097/MD.0000000000011135 DOI: https://doi.org/10.1097/MD.0000000000011135
Mirhaghi, A., Heydari, A., Mazlom, R., & Hasanzadeh, F. (2015). Reliability of the emergency severity index: Meta-analysis. Sultan Qaboos University Medical Journal, 15(1), e71–77. DOI: https://doi.org/10.18295/2075-0528.1656
Monteerarat, Y., Limthongthang, R., Laohaprasitiporn, P., & Vathana, T. (2022). Reliability of capillary refill time for evaluation of tissue perfusion in simulated vascular occluded limbs. European Journal of Trauma and Emergency Surgery, 48(2), 1231–1237. https://doi.org/10.1007/s00068-020-01594-9 DOI: https://doi.org/10.1007/s00068-020-01594-9
Ristanto, R., & Zakaria, A. (2018). Akurasi oxygen saturation (SPO2) sebagai prediktor mortality pada klien cedera kepala. Jurnal Kesehatan Mesencephalon, 4(2), 94–98. https://doi.org/10.36053/mesencephalon.v4i2.87 DOI: https://doi.org/10.36053/mesencephalon.v4i2.87
Sansone, C. M., Prendin, F., Giordano, G., Casati, P., Destrebecq, A., & Terzoni, S. (2017). Relationship between capillary refill time at triage and abnormal clinical condition: A prospective study. The Open Nursing Journal, 11, 84–90. https://doi.org/10.2174/1874434601711010084 DOI: https://doi.org/10.2174/1874434601711010084
Satici, M. O., Islam, M. M., Satici, C., Uygun, C. N., Ademoglu, E., Altunok, İ., Aksel, G., & Eroglu, S. E. (2022). The role of a noninvasive index ‘Spo2/Fio2’ in predicting mortality among patients with COVID-19 pneumonia. American Journal of Emergency Medicine, 57(1), 54–59. https://doi.org/10.1016/j.ajem.2022.04.036 DOI: https://doi.org/10.1016/j.ajem.2022.04.036
Wong, A. K. I., Charpignon, M., Kim, H., Josef, C., De Hond, A. A. H., Fojas, J. J., Tabaie, A., Liu, X., Mireles-Cabodevila, E., Carvalho, L., Kamaleswaran, R., Madushani, R. W. M. A., Adhikari, L., Holder, A. L., Steyerberg, E. W., Buchman, T. G., Lough, M. E., & Celi, L. A. (2021). Analysis of discrepancies between pulse oximetry and arterial oxygen saturation measurements by race and ethnicity and association with organ dysfunction and mortality. JAMA Network Open, 4(11), 1–14. https://doi.org/10.1001/jamanetworkopen.2021.31674 DOI: https://doi.org/10.1001/jamanetworkopen.2021.31674
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Author(s). Published by Lithuanian Sports University.
This work is licensed under a Creative Commons Attribution 4.0 International License.
