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Original Research |

The Power of Flash Mob Research – Conducting a nationwide observational clinical study on Capillary Refill Time in a single day

Jelmer Alsma, MD; Jan LCM van Saase, MD, PhD; Prabath WB Nanayakkara, MD, PhD; WEM Ineke Schouten, MD; Anique Baten, MD; Martijn P. Bauer, MD, PhD; Frits Holleman, MD, PhD; Jack JM. Ligtenberg, MD, PhD; Patricia M. Stassen, MD, PhD; Karin A. Kaasjager, MD, PhD; Harm Haak, MD, PhD; Frank H. Bosch, MD, PhD; Stephanie CE. Schuit, MD, PhD
Author and Funding Information

Declaration of interests

All authors declare no conflict of interests.

1Department of Internal Medicine, Erasmus University Medical Center Rotterdam, s-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands

2Section Acute Medicine, Department of Internal Medicine, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands

3Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, the Netherlands

4Department of Internal Medicine, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, the Netherlands

5Department of Infectious Diseases, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands

6Section Acute Medicine F4-112, Department of Internal Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands

7Emergency Department, Department of Internal Medicine, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands

8Department of Internal Medicine, Division General Medicine, section Acute Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands

9Maastricht University, Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200 MD Maastricht, the Netherlands

10Department of Internal Medicine, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands

11Department of Internal Medicine, Máxima Medical Centre,Dominee Theodor Fliednerstraat 1, 5631 BM Eindhoven, the Netherlands

12Department of Internal Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands

13Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands

Corresponding author: Jelmer Alsma MD Department of Internal Medicine, Erasmus University Medical Center, s-Gravendijkwal 230 3015 CE Rotterdam, the Netherlands


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.11.035
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Abstract

Background  Capillary refill time (CRT) is a clinical test used to evaluate the circulatory status of patients, and there are various methods 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 using a novel methodology of research called ‘Flash Mob Research’ (FMR).

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

Results  On October 29th 2014, 458 investigators in 38 Dutch hospitals enrolled 1.734 patients. The mean CRT measured at the distal phalanx were 2.3 seconds (5s, SD1.1) and 2.4 seconds (15s, SD1.3). The mean CRT measured at the sternum were 2.6 seconds (5s, SD1.1) and 2.7 seconds (15s, SD1.1). 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 to sternal CRT. FMR proved a valuable instrument to investigate a relative simple clinical question in an inexpensive, quick and reliable manner.


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