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. 2025 Oct;39(5):831-840.
doi: 10.1007/s10877-025-01271-5. Epub 2025 Feb 26.

DiCARTTM device to measure capillary refill time: a validation study in patients with acute circulatory failure

Alexandre Descamps  1   2 , Matthias Jacquet-Lagrèze  1   2   3 , Thomas Aussal  1 , Jean-Luc Fellahi  1   2   3 , Martin Ruste  4   5   6
Affiliations

DiCARTTM device to measure capillary refill time: a validation study in patients with acute circulatory failure

Alexandre Descamps et al. J Clin Monit Comput. 2025 Oct.

Abstract

Capillary Refill Time (CRT) is a valuable metric to assess cutaneous perfusion. Its prognostic value in patients with acute circulatory failure has been reported as improved when the measurement is standardized. The DiCART™ device is a fully automated CRT measurement tool requiring validation. We conducted a comparative interventional single-center study including 25 patients with acute circulatory failure, to evaluate the agreement between CRT measured by an automated measurement device (CRTDiCART) and CRT measured clinically (CRTCLIN). CRT was measured on the fingertip, chest, and knee. Three measurements were performed at each location to obtain an average for each site. The measurements were conducted both clinically and using the DiCART™ device by two different operators, each blinded to the results. Agreement was determined using intraclass correlation coefficient (ICC) and Bland and Altman analysis. The ICC between CRTCLIN and CRTDiCART was 0.46 (95% Confidence Interval (CI) 0.32, 0.59) across all measurement sites; the mean bias was 0.23s (95% CI -0.17, 0.64), with upper Limit of Agreement (LoA) 2.77s (95% CI 2.44, 3.20) and lower LoA - 2.30s (-2.73, -1.97). Intra observer ICC was 0.85 (95% CI 0.74, 0.91) for CRTCLIN and 0.43 (95% CI 0.15, 0.64) for CRTDICART. Inter observer ICC was 0.86 (95% CI 0.76, 0.92) for CRTCLIN and was 0.41 (95% CI 0.14, 0,63) for CRTDICART. The DiCART™ device showed poor agreement with clinical CRT in patients with acute circulatory failure, which does not support its use in routine practice.

Keywords: Acute circulatory failure; Capillary refill time; DiCART™; Validation, agreement.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: The study protocol was registered in Clinicaltrials.gov (NCT05847998). The institutional review board, Comité de protection des personnes Sud-Méditerranée I (IRB: N° ID-RCB 2021-A02595-36) approved the study protocol. In agreement with the French law n° 2012 − 300 of March 5, 2012, informed consent of the patients (or their support person when the patient could not be informed) was systematically obtained before the inclusion. Consent for publication: Not applicable. Take home message: DiCART™ is a full automatized handled device to assess capillary refill time. Its agreement with clinical evaluation of capillary refill time is poor. Its reproducibility is lower than clinical evaluation of capillary refill time. Competing interests: MJL is cofounder and shareholder of the DiCARTECH company that has been created to build and sell a device that measures capillary refill time. AD, TA, JF, MR have no conflicts of interest related to the study to declare.

Figures

Fig. 1
Fig. 1
DiCART™ device. A: Spring connected to the pressure sensor; B: Start trigger; C: Screen displaying adynamic gauge of exerted pressure; D: Camera; E: Piston; F: Temperature sensor
Fig. 2
Fig. 2
Experimental design of the study. CRT: Capillary refill time, CRTCLIN: Clinical measurement of CRT, CRTDICART: CRT measured with the DiCART™ automated device. Each measurement was performed 3 times to determine a mean CRT. Fingertip CRT assessments were carried out alternately by observer 1 and 2 in the shortest possible time
Fig. 3
Fig. 3
Bland and Altman plot assessing the agreement between the DiCART™ device and clinical measurement for capillary refill time (all measurement sites). LoA: limit of agreement, represented with their 95% confidence interval; x: capillary refill time measured with clinical method; y: capillary refill time measure with DiCART™ method. Dashed lines represent the acceptable limits of agreement defined a priori in the study
Fig. 4
Fig. 4
Receiver operating characteristic curve of the DiCART™ diagnostic performance to detect a capillary refill time higher than 3 s. ROC-AUC: area under the receiver characteristic curve, with its 95% confidence interval
See this image and copyright information in PMC

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