Sepsis remains the 9th leading cause of disease-related death and the primary cause of infection-related death in the ICU. Sepsis is a devastating disease that results in over 250,000 deaths and 1.3 million hospitalizations per year. In February 2016, the Third International Consensus on Sepsis published “Sepsis 3.0,” the first new sepsis guidelines since 2003. The new guidelines were welcomed by many since the long interval time since “Sepsis 2.0,” but have already created a firestorm of controversy especially in emergency medicine. Much of this controversy is due to the move away from the systemic inflammatory response syndrome (SIRS) criteria in favor of the sequential organ failure assessment score (SOFA) and qSOFA scores. I encourage everyone to read the three excellent articles published by the “Sepsis 3.0” consensus group in the Journal of the American Medical Association (JAMA).

These scoring systems all rely upon a high index of clinical suspicion. Frequently forgotten in all of the labs and rads is the physical examination. Septic patients as well as those with significant dehydration/hypovolemia, and trauma patients will have prolonged capillary refill. Do you know how to recognize it? I remember on my pediatrics rotations as a medical student being reminded again and again to check capillary refill and if it was less than 2 seconds, it was normal. So what is borderline and what are abnormal capillary refill times? If you are unsure, then check out this new simulation-based app from Jump Simulation and OSF Healthcare called Capillary Refill Trainer. This app teaches the proper classification via “realistic” patient scenarios in a simulation game. The app designers are the same team behind apps such as Hospital Readmission Challenge, AR Anatomy, and C. diff Risk Challenge, which we previously reviewed.

Evidence-based medicine

Capillary Refill Trainer provides a unique “serious game” case-based simulation to ensure users can properly classify normal, borderline, and abnormal capillary refill. The app lacks any reference materials or further information about the importance and/or relevance of capillary refill. The app comes from a reputable design team, Jump Simulation — who, in addition to national recognition for hands-on and online simulation, has additionally won numerous simulation app design awards and recognition from several simulation societies. Furthermore, Capillary Refill is part of several other game-based apps from OSF Healthcare in Peoria which is part of the University of Illinois College of Medicine healthcare system.

Who would benefit from this App?

Students, nurses, residents, mid-levels, and faculty in any specialty who care for patients with sepsis, or any patient requiring capillary refill assessment.

Price

 Free

Likes

  • Game-based simulation to teach proper capillary refill classification
  • Helpful tutorial to ensure users understand the animated cases
  • Available for Android

Dislikes

  • Graphics are animations rather than realistic looking patients
  • Tutorial must be fully completed to access game
  • No educational materials, references, or other information about the game/scenarios

Overall

Capillary Refill trainer is a simulation game that effectively teaches the basics of proper classification of capillary refill. The game is designed primarily with a sepsis backdrop but could be applied to dehydration, trauma, etc. Unfortunately, the game lacks any additional information, references, teaching materials beyond the basic patient scenarios.

Overall Score

  • 4.5/5 stars

User Interface

  • 4.0/5 stars

Easy-to-use interface including a helpful tutorial. The app could be improved with more information on why mastery of this skill is important, uses of the skill beyond sepsis, etc..

Multimedia Usage

  • 4.5/5 stars

The app has multiple patient scenarios use animated graphics to illustrate normal, borderline, and abnormal capillary refill. The graphics are basic but sufficient.

Price

  •  5/5 stars

The app is free.

Real-World Applicability

  • 4.5/5 stars

This is a simple but important “serious game” and excellent use of simulation to teach the basics of capillary refill to healthcare providers. The app likely does not warrant much repeat “play” once it has been used initially, but periodic retraining is not unreasonable.

Device Used For Review

o iPhone 8 running iOS 12.1.2

Available for Download for iPhone, iPad, and Android.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.