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Original Research: Practice Management and Administration |

The Power of Flash Mob Research: Conducting a Nationwide Observational Clinical Study on Capillary Refill Time in a Single Day

Jelmer Alsma, MD; Jan L.C.M. van Saase, MD, PhD; Prabath W.B. Nanayakkara, MD, PhD; W. E. M. Ineke Schouten, MD; Anique Baten, MD; Martijn P. Bauer, MD, PhD; Frits Holleman, MD, PhD; Jack J.M. Ligtenberg, MD, PhD; Patricia M. Stassen, MD, PhD; Karin H.A.H. Kaasjager, MD, PhD; Harm R. Haak, MD, PhD; Frank H. Bosch, MD, PhD; Stephanie C.E. Schuit, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands

bDepartment of Emergency Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands

cSection Acute Medicine, Department of Internal Medicine, VU University Medical Centre, Amsterdam, the Netherlands

dDepartment of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

eDepartment of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands

fDepartment of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands

gSection Acute Medicine, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands

hEmergency Department, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands

iDepartment of Internal Medicine, Division General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands

jMaastricht University, Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands

kDepartment of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands

lDepartment of Internal Medicine, Máxima Medical Centre, Eindhoven, the Netherlands

mDepartment of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands

nDepartment of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands

CORRESPONDENCE TO: Jelmer Alsma, MD, Department of Internal Medicine, Erasmus University Medical Center, s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1106-1113. doi:10.1016/j.chest.2016.11.035
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Background  Capillary refill time (CRT) is a clinical test used to evaluate the circulatory status of patients; various methods are available to assess CRT. Conventional clinical research often demands large numbers of patients, making it costly, labor-intensive, and time-consuming. We studied the interobserver agreement on CRT in a nationwide study by using a novel method of research called flash mob research (FMR).

Methods  Physicians in the Netherlands were recruited by using word-of-mouth referrals, conventional media, and social media to participate in a nationwide, single-day, “nine-to-five,” multicenter, cross-sectional, observational study to evaluate CRT. Patients aged ≥ 18 years presenting to the ED or who were hospitalized were eligible for inclusion. CRT was measured independently (by two investigators) at the patient’s sternum and distal phalanx after application of pressure for 5 s (5s) and 15 s (15s).

Results  On October 29, 2014, a total of 458 investigators in 38 Dutch hospitals enrolled 1,734 patients. The mean CRT measured at the distal phalanx were 2.3 s (5s, SD 1.1) and 2.4 s (15s, SD 1.3). The mean CRT measured at the sternum was 2.6 s (5s, SD 1.1) and 2.7 s (15s, SD 1.1). Interobserver agreement was higher for the distal phalanx (κ value, 0.40) than for the sternum (κ value, 0.30).

Conclusions  Interobserver agreement on CRT is, at best, moderate. CRT measured at the distal phalanx yielded higher interobserver agreement compared with sternal CRT measurements. FMR proved a valuable instrument to investigate a relatively simple clinical question in an inexpensive, quick, and reliable manner.

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