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For Immediate Release

Children’s Hospital of Pittsburgh Physicians Find that Recognizing Shock in Children Early On Can Prevent Death

Doctors encourage parents/physicians to use simple method to recognize shock and save lives

Children’s Hospital of Pittsburgh doctors have determined that early recognition and prompt treatment of pediatric shock in community hospitals helps save lives and improves outcomes of young patients.

Doctors have determined in a recent study that parents, nurses and physicians can save lives by using a simple technique to recognize shock called capillary refill. Using successful shock reversal therapies can increase the survival of an ill or injured child suffering from septic shock by 40 percent, Children’s doctors have found through a decade-long study.

The method is simple – a child’s fingertip is gently pressed and then the time until refilling of the fingertip regains its pink color is measured. The pink color should return in less than two seconds, said Joseph Carcillo, MD, of Children’s Critical Care Medicine Division and lead author. The paper is published in the October issue of Pediatrics, which is the premiere publication of the American Academy of Pediatrics.

There are two conditions that can lead to a capillary refill taking longer than two seconds.

“A child who is cold, for example, after taking a bath or in outside cold weather without mittens can take longer than two seconds to return to a normal coloring. These children are playful and smiling,” said Dr. Carcillo. “However, the second condition is shock. If a child is not smiling and playing, and the refill of the capillary bed is greater than two seconds, the child needs immediate attention. Appropriate therapies given in the community hospital can be most effective in saving children in this early stage of shock.”

In a study of nearly 100 patients over a 10-year period, Children’s doctors were able to determine that when community hospitals, primary care physicians and families recognized and treated children for shock prior to coming to Children’s the mortality rate decreased dramatically. Researchers looked at whether outside resources (doctors, nurses or parents) recognized the disease, if medicine was administered prior to the patient arriving at Children’s and if that affected the child’s outcome.

Since the number one cause of death in children is shock, Dr. Carcillo recommends all parents learn the capillary refill maneuver and use it if their child is not feeling well. “What we found was that for every hour a child was not treated, his or her risk of dying went up by 40 percent,” Dr. Carcillo said. “By recognizing shock and following the clinical guidelines early on in a child’s treatment researchers found there was little chance of death among children.”

The American College of Critical Care Medicine-Pediatric Advanced Life Support Guidelines used in this study were published last year by the American College of Critical Care Medicine and under the direction of Dr. Carcillo. In addition to the capillary refill test, some other warning signs a child is going into shock include: fast heart rate, decrease in blood pressure, crying, frightfulness and sleepiness.

Others involved in the research are: Yong Han, MD; Michelle Dragotta, RN; Debra Bills, RN; Scott Watson, MD; Mark Westerman, RT; and Richard Orr, MD, all from Children’s.

Melanie Finnigan, 412-692-5016,
Marc Lukasiak, 412-692-5016,

Last Update
February 19, 2008
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Last Update
February 19, 2008