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Nah S, Choi S, Kang N, Bae KY, Kim YR, Kim M, Moon JE, Han S. An augmented reality mobile application for weight estimation in paediatric patients: A prospective single-blinded cross-sectional study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:660-668. [PMID: 38920159 DOI: 10.47102/annals-acadmedsg.20238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Determining the exact weight of children is a challenging task during emergency situations. Current guidelines recommend the use of length-based weight-estimating tapes. However, healthcare providers must either always carry the tapes or take time to locate them. Moreover, they may not know how to use them. To address these issues, we developed an augmented reality smartphone application for length-based weight estimation called the Paediatric Augmented Reality Scale (PARS). We evaluated its performance and compared it to that of the Broselow tape (BT) and Paediatric Advanced Weight Prediction in the Emergency Room extra-long and extra-large (PAWPER-XL) tape methods. Method A prospective, single-blinded cross-sectional study was conducted with children aged 1 month to 12 years who visited the emergency department of the tertiary university hospital in Bucheon, South Korea between July 2021 and February 2022. This study aimed to evaluate the measurement agreement and performance of 3 methods: BT, PAWPER-XL and PARS. Results In all, 1090 participants were enrolled, and 639 (58.6%) were male. The mean age of the participants was 4.1 ± 2.8 years, with a mean height of 102.7 ± 21.7 cm and mean weight of 18.8 ± 9.5 kg. Compared to BT and PAWPER-XL, PARS exhibited lower mean absolute percentage error (9.60%) and root mean square percentage error (3.02%). PARS achieved a higher proportion of weights estimated within 10% of the actual weight (63.21%), outperform-ing BT (57.25%) and PAWPER-XL (62.47%). The intraclass correlation coefficients for the actual and estimated weights of BT, PAWPER-XL and PARS were 0.952, 0.969 and 0.973, respectively (P<0.001). Conclusion PARS exhibited a modestly better performance than BT and PAWPER-XL in estimating body weight. PARS-estimated body weights correlated fairly accurately with the actual body weights. PARS holds potential utility in paediatric emergencies.
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Affiliation(s)
- Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Nayeon Kang
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Kyung Yoon Bae
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ye Rim Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Minsol Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ji Eun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Yakubu RC, Paintsil V, Nguah SB. Weight estimation in two groups of Ghanaian children with chronic diseases using Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes. Afr J Emerg Med 2023; 13:109-113. [PMID: 37152659 PMCID: PMC10154971 DOI: 10.1016/j.afjem.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The performance of various weight estimation methods in children with sickle cell disease (SCD) and heart disease (HD) has not been studied. We aimed to determine and compare the accuracies of the Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes in Ghanaian children with no known chronic diseases (controls), SCD and HD. Methods We prospectively recruited 631 children (199 with HD, 209 SCD and 223 controls) from the Komfo Anokye Teaching Hospital (KATH). Their weights were estimated using the Broselow, Mercy, PAWPER XL and PAWPER XL-MAC tapes. These estimated weights were compared to measured weight using mean percentage error (MPE), the proportion of weight estimates within ±10% (P10) and ±20% (P20) of measured weight. Bland-Altman limits of agreement (LOA) were determined to assess the precision of weight estimation and agreement with measured weight. Results The PAWPER XL, Mercy and PAWPER XL-MAC were the most accurate in all groups of children studied. All methods except the Broselow tape (BT), which performed best in the control group, had their best performance among children with SCD with negligible critical error rates (proportion of children with weight estimates > 20% of their actual weight). The P20 in the various groups of children using the BT were 88.36%, 80.21% and 51.10% respectively in the control, SCD and HD groups. The Mercy, PAWPER XL and PAWPER XL MAC tapes were generally above 90% in all groups. Discussion The Mercy, PAWPER XL and PAWPER XL-MAC tapes performed significantly better than the BT in all groups of children studied. These methods of weight estimation performed best in children with SCD with very little critical error.
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Affiliation(s)
- Rafiuk Cosmos Yakubu
- School of Medicine, University for Development Studies, Tamale, Ghana
- Tamale Teaching Hospital, Tamale, Kumasi, Ghana
- Corresponding author at: Tamale Teaching Hospital, Tamale, Kumasi, Ghana.
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Samuel Blay Nguah
- School of Medicine, University for Development Studies, Tamale, Ghana
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Silvagni D, Baggio L, Mazzi C, Cuffaro G, Carlassara S, Spada S, Biban P. The PAWPER tape as a tool for rapid weight assessment in a Paediatric Emergency Department: Validation study and comparison with parents’ estimation and Broselow tape. Resusc Plus 2022; 12:100301. [PMID: 36148444 PMCID: PMC9486114 DOI: 10.1016/j.resplu.2022.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Davide Silvagni
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Laura Baggio
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Cristina Mazzi
- Clinical Research Unit, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
- Centre for Clinical Research, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giorgio Cuffaro
- Pediatrics Residency, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Silvia Carlassara
- Pediatrics Residency, Department of Surgical Sciences, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Simona Spada
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
| | - Paolo Biban
- Pediatric Emergency Room – Department of Neonatal and Pediatric Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy
- Corresponding author at: Department of Pediatric and Neonatal Critical Care, University Hospital of Verona, Piazzale Stefani 1, 37126 Verona, Italy.
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Cosmos Yakubu R, Ayi-Bisah N, Nguah SB. Accuracy of Weight Estimation in Children Using the Broselow, PAWPER XL, PAWPER XL-MAC, and Mercy Tapes. Pediatr Emerg Care 2022; 38:e1517-e1522. [PMID: 36040471 DOI: 10.1097/pec.0000000000002638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Quick and accurate estimate of a child's weight is often required for medical interventions like drug dose calculation when scale measured weights cannot be obtained safely. Length-based methods of weight estimation are more accurate than age-based methods, with the most accurate being the length-based, habitus-modified methods. This study sought to determine and compare the accuracies of the 2017 Broselow tape, Paediatric Advanced Weight Prediction in the Emergency Room Extra-Long (PAWPER XL) tape, Paediatric Advanced Weight Prediction in the Emergency Room Extra-Long Mid-Arm Circumference (PAWPER XL-MAC) tape, and the 2-dimensional (2D) Mercy tape in Ghanaian children. METHODS A cross-sectional study was conducted at the Tamale Teaching Hospital in Ghana. Eight hundred forty children between 2 months and 13 years had their weights estimated by the 2017 Broselow, PAWPER XL, PAWPER XL-MAC, and 2D Mercy tapes. Accuracy of the methods was determined by percentage of weight estimated to within 10% and 20% of actual weight. Mean percentage error and the Bland-Altman analysis were used to assess bias and precision. RESULTS The proportion of weight estimates within 10% and 20% of actual weight for Broselow tape were 47.5% and 82.3%, for 2D Mercy tape were 73.1% and 96.3%, for PAWPER XL-MAC were 77.6% and 97.5%, and for PAWPER XL were 81.7% and 96.8%, respectively. The Broselow tape had the greatest bias and least precision among the 4 methods. The Mercy, PAWPER XL-MAC, and PAWPER XL tapes had similar performance, but all performed significantly better than the Broselow tape in pairwise comparison. The best weight estimation method overall was the PAWPER XL tape as it also had the least bias and greatest precision. CONCLUSIONS The Mercy, PAWPER XL-MAC, and PAWPER XL tapes were more accurate than the 2017 Broselow tape and should be used in preference in Ghana and countries with similar population structure.
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Saeed W, Akbar A, Waseem M, Kuchinski AM, Xu H, Gibson RW. Addition of Midthigh Circumference Improves Predictive Ability of Broselow Tape Weight Estimation. Pediatr Emerg Care 2022; 38:448-452. [PMID: 35686959 DOI: 10.1097/pec.0000000000002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to improve the accuracy of Broselow tape (BT) weight prediction by adding midthigh circumference (MTC) and to compare and standardize the methods for measuring MTC. METHODS This prospective, observational study was conducted in a pediatric emergency department of a tertiary care children's hospital. Children up to 12 years of age presenting to emergency department were included. Children were excluded if obtaining the data would interfere with their acute management. The data collected included MTC, height, BT weight, and actual weight. Three models were built. Broselow tape-only model and MTC plus BT model used 2 methods for MTC measurements: visual approximation of thigh midpoint (visual MTC1) and Centers for Disease Control and Prevention (CDC)-defined method (CDC MTC2). RESULTS A total of 430 children were enrolled during pre-coronavirus disease era. Of these, 234 were boys (54.4%) and 196 (45.6%) were girls. Data were categorized into children younger than 2 years (224 [52.1%]) and older than 2 years (206 [47.9%]). African American constituted 250 (58%); White, 136 (31%); and unspecified, 27 (6%). For the entire cohort, both models that included MTC were significantly better at weight prediction with larger adjusted R2 (visual MTC1, 0.921; CDC MTC2, 0.928) and smaller root mean squared (RMSE) (visual MTC1, 2.70; CDC MTC2, 2.56) compared with BT-only model (adjusted R2 = 0.843; RMSE, 3.80). Midthigh circumference plus BT models performed even better in children older than 2 years compared with BT-only model with adjusted R2 (visual MTC1, 0.859; CDC MTC2, 0.872 vs 0.616) and RMSE (visual MTC1, 3.18; CDC MTC2, 3.03 vs 5.27). CONCLUSIONS The inclusion of MTC with BT resulted in a more accurate weight prediction in children especially greater than 2 years old. Midthigh circumference model using CDC-defined method was slightly better predictor of actual weight than visual approximation.
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Affiliation(s)
- Wajeeha Saeed
- From the Department of Pediatric Emergency Medicine, Medical College of Georgia, Augusta University
| | - Amber Akbar
- Medical Scholars Program, Medical College of Georgia, Augusta, GA
| | - Muhammad Waseem
- Department of Pediatric Emergency Medicine, Lincoln Medical Center, NY
| | | | - Hongyan Xu
- Population Health Science: Biostats and Data Science, Medical College of Georgia, Augusta University, Augusta, GA
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Czarnecki RW, Harik LG, Malthaner LQ, Shi J, Leonard JC. Roll up the tape? Laser and optical technologies improve paediatric weight estimation. Resuscitation 2020; 157:41-48. [PMID: 33031873 DOI: 10.1016/j.resuscitation.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/21/2020] [Accepted: 09/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND A robust estimation method is needed to prevent medication dosing and equipment sizing errors and improve time to administration during paediatric resuscitation. An electronic measurement with computer interface may improve accuracy and alleviate cognitive burden. This study evaluates the accuracy of two electronic height measurement methods, a laser and an optical device, and compares them to the Broselow™ Pediatric Emergency Tape (BT) for weight estimation. METHODS We enrolled children ages 0-14 years from the emergency department of a free-standing, academic children's hospital. We obtained sex, body habitus, true weight, true height, BT colour, and experimental heights. We converted experimental height measurements into weight estimates using standardised growth charts. We calculated Pearson correlations between experimental and actual measurements and the percentages of weight estimates within 10% and 20% of true weights. We repeated analyses on a restricted cohort of children 0-11 years, the intended BT age range. RESULTS We enrolled 198 children. The laser, optical device and BT weight estimates had strong positive correlations with the actual weight measurements with Pearson's correlation coefficients of 0.946, p < 0.0001, 0.965, p < 0.0001, and 0.825, p < 0.0001 respectively. 47.8% of optical weight estimates fell within 10% of actual weight and 80.6% within 20%, compared to 40.5% and 75.4% of laser estimates and 39.8% and 65.1% of BT estimates. CONCLUSION Electronic-based weight estimates were more accurate than the BT. The accuracy of medication dosing and equipment sizing during paediatric resuscitation may be improved by integrating optical height-based weight estimates with electronic clinical decision support.
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Affiliation(s)
- Ryan W Czarnecki
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, United States
| | - Lamia G Harik
- Weill Cornell Medical College/New York-Presbyterian Hospital, United States
| | - Lauren Q Malthaner
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, United States
| | - Junxin Shi
- Biostatistics Research Core, Abigail Wexner Research Institute at Nationwide Children's Hospital, United States
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital and The Ohio State University Wexner Medical Center, United States; Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, United States.
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Park JW, Kwon H, Jung JY, Choi YJ, Lee JS, Cho WS, Lee JC, Kim HC, Lee SU, Kwak YH, Kim DK. "Weighing Cam": A New Mobile Application for Weight Estimation in Pediatric Resuscitation. PREHOSP EMERG CARE 2020; 24:441-450. [PMID: 31368831 DOI: 10.1080/10903127.2019.1651432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: We evaluated the validity of a newly developed mobile application (i.e. the Weighing Cam) for pediatric weight estimation compared with that of the Broselow tape. Methods: We developed an application that estimates the weight of pediatric patients using a smartphone camera and displays the drug dosage, device size, and defibrillation energy on the screen of the smartphone. We enrolled a convenience sample of pediatric patients aged <16 years who presented at two pediatric emergency departments of two tertiary academic hospitals in South Korea. The pediatric patients' heights and weights were measured; then, one researcher estimated the weights using the application. Using the measured height, we determined the weight estimated by the Broselow tape. We compared the estimated measurements by determining the mean percentage error (MPE), mean absolute percentage error, root mean square percentage error, and percentages predicted within 10% and 20% of the actual. Results: In total, 480 patients were enrolled in 16 age categories, each with 15 males and 15 females of different ages. The Weighing Cam demonstrated a lower bias (mean difference: -1.98% [95% confidence interval -2.91% to -1.05%] for MPE) and a higher proportion of estimated weights within 10% of the actual weights than the Broselow tape (mean difference: 9.1% [95% confidence interval 3.0% to 15.1%]). The Weighing Cam showed better performance in terms of accuracy and precision than the Broselow tape in all subgroups stratified by age or body mass index percentile. Conclusions: The Weighing Cam may estimate pediatric patients' weights more accurately than the Broselow tape. The Weighing Cam may be useful for pediatric resuscitation in both prehospital and hospital settings.
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Comparison of weight estimation methods in hospitalized Brazilian children and adolescents. NUTR HOSP 2020; 37:243-250. [PMID: 31960691 DOI: 10.20960/nh.02594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: in emergencies or in situations involving critically ill patients, an accurate calculation of body weight is essential to ensure adequate medical care. Generally, simple techniques are used to determine weight. Aim: to evaluate the weight estimation methods Advanced Paediatric Life Support (APLS) Update, Luscombe and Owens, Best Guess, and the Broselow tape, comparing measured weight with the weight estimated by each method in hospitalized Brazilian children and adolescents. Methods: an observational study in which anthropometric data were collected from patients of 0-14 years of age between August 2016 and January 2017. The paired t-test was used to compare the patients' measured weight with their estimated weight. The accuracy of each method was analyzed using Bland-Altman plots and Lin's concordance correlation coefficient. Results: the sample consisted of 446 patients. Most of the patients were male (58.1%), of 1-5 years of age (43%) and well nourished (85%). For those under 12 months of age, the APLS Update and Best Guess methods performed best, with the difference in means of measured weight and estimated weight being 0.4 kg (p = 0.183) and -0.2 kg (p = 0.140), respectively. In the 1-5 years of age group only the APLS Update yielded satisfactory results (0.2 kg; p = 0.200). The best agreement with measured weight, according to the Bland-Altman plots and Lin's coefficient, was found for the Broselow tape (CC = 0.96). Conclusion: of the estimation methods evaluated the Broselow tape was the most accurate one. Further studies are required to adapt this method for use in the Brazilian population, thus ensuring its appropriate application in this country.
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Wells M, Goldstein LN. How and Why Paediatric Weight Estimation Systems Fail - A Body Composition Study. Cureus 2020; 12:e7198. [PMID: 32269878 PMCID: PMC7137653 DOI: 10.7759/cureus.7198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/07/2020] [Indexed: 01/27/2023] Open
Abstract
Background Weight estimation during medical emergencies in children is essential, but fraught with errors if the wrong techniques are used, which may result in critical drug dosing errors. Individualised weight estimation is required to allow for accurate dosing in underweight and obese children in particular. This study was designed to evaluate the associations between weight estimations from different systems and body composition in order to establish how and why they may perform well or poorly. Methods A convenience sample of 332 children aged from one month to 16 years had weight estimations using four age-based formulas: the Broselow™ Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL), the Mercy Method, and the Pediatric Advanced Weight Prediction in the Emergency Room, Extra-large/Extra-long Tape (PAWPER XL) Tape. They also had an assessment of body composition using dual x-ray absorptiometry (DXA). The weight estimates were compared against total body weight (TBW), calculated ideal body weight (IBW), and DXA-measured fat-free mass (FFM). Analyses of associations between age, length, weight estimation outcomes, and body composition were performed. Results Age-based formulas were very inaccurate because of the erratic relationship between age and body composition. The Broselow tape estimated IBW well in obese children because of the strong relationship between length and fat-free mass. It predicted TBW poorly in underweight and obese children, however, because of the poor relationship between length and fat mass. The Mercy Method's performance was unrelated to body composition, but estimated TBW reasonably well and could not predict IBW or FFM. The PAWPER XL Tape's performance was the most closely associated with body composition and, therefore, achieved an acceptable accuracy for estimations of TBW, IBW, and FFM. Conclusions Of the systems evaluated, the PAWPER XL Tape has the best association with body composition and the most accurate estimations of TBW, IBW, and FFM.
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Affiliation(s)
- Mike Wells
- Emergency Medicine, University of the Witwatersrand, Johannesburg, ZAF
| | - Lara N Goldstein
- Emergency Medicine, University of the Witwatersrand, Johannesburg, ZAF
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Schmidt AR, Buehler PK, Meyer J, Weiss M, Schmitz A, Both CP. Length-based body weight estimation in paediatric patients: The impact of habitus-A clinical observational trial. Acta Anaesthesiol Scand 2018; 62:1389-1395. [PMID: 29943477 DOI: 10.1111/aas.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Paediatric emergency tapes provide drug dosing based on the patient's estimated body weight. Unfortunately, published data revealed an unsatisfactory accuracy. A newly developed digital algorithm for weight estimation (CLAWAR) allowing a three-staged habitus adaptation (normal, obese, or cachectic; CLAWAR-3) demonstrated a higher accuracy for weight estimation compared to paediatric emergency tapes. However, the incidence of incorrectly evaluated habitus was 27%. A five-staged habitus adaptation with figural images was suggested by Wells et al to improve habitus and weight estimation. Therefore, CLAWAR was modified with five habitus stages including figural images (CLAWAR-5). We hypothized CLAWAR-5 improves the accuracy of weight estimation. METHODS After obtaining informed written parental consent patients were included in this single centre, prospective clinical observation trial. Body weight estimations by CLAWAR-3 and CLAWAR-5 within ±10% of the actual body weight were compared. Furthermore, the incidence of correct evaluated habitus was calculated. McNemar Tests were used for statistical analysis. Results presented as median (interquartiles), P < .003 considered significant. RESULTS In total, 312 patients aged 3.3 years (0.7-6.6), with a body length of 95.9 cm (70.0-121.2), weighing 14.8 kg (8.1-22.5), were included. Both CLAWAR-3 and CLAWAR-5 showed equivalent accuracy for weight estimation within the ±10% interval (62.2% vs 60.6%, P = .609). Despite adding figural images, the incidence of correct evaluated habitus with CLAWAR-5 (46.8%) was worse than with CLAWAR-3 (66.7%). CONCLUSION The five-staged habitus-adapted method could not improve the accuracy of weight estimation. Furthermore, the error rate of habitus classification was not reduced by the implementation of figural images.
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Affiliation(s)
- A. R. Schmidt
- Department of Anaesthesia University Children's Hospital Zurich Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Zurich Switzerland
| | - P. K. Buehler
- Department of Anaesthesia University Children's Hospital Zurich Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Zurich Switzerland
| | - J. Meyer
- Department of Anaesthesia University Children's Hospital Zurich Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Zurich Switzerland
| | - M. Weiss
- Department of Anaesthesia University Children's Hospital Zurich Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Zurich Switzerland
| | - A. Schmitz
- Department of Anaesthesia University Children's Hospital Zurich Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Zurich Switzerland
| | - C. P. Both
- Department of Anaesthesia University Children's Hospital Zurich Zurich Switzerland
- Children's Research Center University Children's Hospital Zurich Zurich Switzerland
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Optimising emergency weight estimation in underweight and obese children: the accuracy of estimations of total body weight and ideal body weight. Eur J Emerg Med 2018; 26:301-307. [PMID: 30044240 DOI: 10.1097/mej.0000000000000561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE During medical emergencies, underweight and obese children are at a higher risk of weight-estimation errors than 'average' children, which may lead to poorer outcomes. In obese children, optimum drug dosing requires a measure of both total body weight (TBW) and ideal body weight (IBW) for appropriate scaling. We evaluated the ability of the Broselow tape, the Mercy method and the PAWPER XL tape to estimate TBW and IBW in obese and underweight children. PARTICIPANTS AND METHODS Data for children aged 0-18 years were extracted and pooled from three previous weight-estimation studies. The accuracy of estimation of TBW and IBW by each method was evaluated using percentage of estimations within 10% of target weight (PW10) as the primary outcome measure. RESULTS The Broselow tape estimated TBW poorly in obese and underweight children (PW10: 3.9 and 41.4%), but estimated IBW extremely accurately (PW10: 90.6%). The Mercy method estimated TBW accurately in both obese and underweight children (PW10: 74.3 and 76.3%) but did not predict IBW accurately (PW10: 14.3%). The PAWPER XL tape predicted TBW well (PW10: 73.0% in obese children and 74.9% in underweight children) and predicted IBW extremely accurately (PW10: 100%). CONCLUSION The Broselow tape predicted IBW, but not TBW, accurately. The Mercy method estimated TBW very accurately, but not IBW. The PAWPER XL tape estimated both TBW and IBW accurately. The PAWPER XL tape should be considered when choosing a weight-estimation strategy for obese and underweight children.
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Wells M, Goldstein LN, Bentley A. The accuracy of paediatric weight estimation during simulated emergencies: The effects of patient position, patient cooperation, and human errors. Afr J Emerg Med 2018; 8:43-50. [PMID: 30456146 PMCID: PMC6223595 DOI: 10.1016/j.afjem.2017.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/07/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The effect of patient position and patient cooperation on the accuracy of emergency weight estimation systems has not been evaluated previously. The objective of this study was to evaluate weight estimation accuracy of the Broselow tape, the PAWPER XL tape, the Mercy method, and a custom-designed mobile phone App in a variety of realistic simulated paediatric emergencies. METHODS This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used each of the four methods to estimate the children's weight. The accuracy of and time taken for the weight estimations were evaluated for each method. A regression analysis determined the effects of patient position and cooperation on weight estimation accuracy. Evaluation of subgroups of best-performers and worst-performers among the participants provided information on the effects of human user-error on weight estimation accuracy. RESULTS The Broselow tape, Mercy method, App and the PAWPER XL tape achieved percentages of weight estimation within 10% of actual weight in 47.7, 57.3, 68.1, and 73.0% of estimations, respectively. Patient position and cooperation strongly impacted the accuracy of the Broselow tape, had a minimal effect on the Mercy method and the App, and had no effect on the PAWPER XL tape. The best performing participants achieved very high accuracy with all methods except the Broselow tape. DISCUSSION The Mercy method, the App, and the PAWPER XL tape achieved exceptionally high accuracy even in uncooperative and sub-optimally positioned children when used by the best-performing participants. Human error, from inexperience and inadequate training, had the most significant impact on accuracy. The Mercy method was the most subject to human error, and the PAWPER XL tape, the least. Adequate training in using weight estimation systems is essential for paediatric patient safety.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa
- Corresponding author.
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Alison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Al-Mendalawi MD. Validity of Broselow tape for estimating weight of Indian children. Indian J Med Res 2018; 146:794. [PMID: 29664042 PMCID: PMC5926355 DOI: 10.4103/ijmr.ijmr_1274_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus. Pediatr Res 2018; 83:83-92. [PMID: 29044227 DOI: 10.1038/pr.2017.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/29/2017] [Indexed: 11/09/2022]
Abstract
BackgroundThe Broselow tape (BT) has been shown to estimate weight poorly primarily because of variations in body habitus. The manufacturers have suggested that a visual assessment of habitus may be used to increase its performance. This study evaluated the ability of habitus-modified models to improve the accuracy thereof.MethodsA post hoc analysis of prospectively collected data from four hospitals in Johannesburg, South Africa, on a population of 1,085 children. Sixteen a priori models generated a modified weight estimation or drug dose based on the BT weight and a gestalt assessment of habitus.ResultsThe habitus-modified method suggested by the manufacturer did not improve the accuracy of the BT. Five dosing and four weight-estimation models were identified that markedly improved dosing and weight estimation accuracy, respectively. The best dosing model improved dosing accuracy (doses within 10% of correct dose) from 52.0 to 69.6% and reduced critical dosing errors from 16.5 to 4.3%. The best weight-estimation model improved accuracy from 59.4 to 81.9% and reduced critical errors from 11.8 to 1.9%.ConclusionThe accuracy of the BT as a drug-dosing and weight-estimation device can be substantially improved by including an appraisal of body habitus in the methodology.
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Wells M, Goldstein LN, Bentley A. The Use of Body Habitus Reference Images Improves the Ability of Novices to Accurately Estimate Children's Weight Using the PAWPER XL Tape System. J Emerg Med 2017; 54:165-175. [PMID: 29169918 DOI: 10.1016/j.jemermed.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/05/2017] [Accepted: 10/07/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The original methodology of the PAWPER (Pediatric Advanced Weight Prediction in the Emergency Room) tape relies on a gestalt visual assessment of a child's body habitus to adjust a length-based weight estimation. This assessment is dependent on the user's subjective opinion, which may result in aberrations in accuracy between users and populations. With the development of the second-generation PAWPER XL tape, a more objective method of habitus evaluation was desired. OBJECTIVE The aim of this study was to evaluate a new, more objective figural reference image system and a new checklist system for quantifying body habitus. METHODS Volunteers were asked to assess the body habitus score of 90 children from a sequence of photographic images using the standard gestalt visual assessment system, a new checklist system, and a system using figural reference images. PAWPER XL tape weight estimations were generated from these scores, which were compared between the three test groups. Participants were also surveyed on their preferences for the different methodologies. RESULTS There were 11,505 habitus score assessments from 138 doctor, nurse, and paramedic participants. The figural reference image system significantly outperformed the checklist system and the gestalt visual assessment system in terms of weight estimation accuracy, achieving 70.9%, 61.1%, and 60.9% of estimations within 10% of measured weight, respectively. The participants expressed a strong subjective preference for the image system because of speed of use, ease of use, perceived accuracy, objectivity, and low cognitive load. CONCLUSIONS The figural reference image system was objectively much more accurate than, and subjectively preferable to, the original gestalt visual estimation methodology.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Alison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Al-Mendalawi MD. The accuracy of Broselow pediatric emergency tape in estimating body weight of pediatric patients. Saudi Med J 2017; 38:1158-158. [PMID: 29114708 PMCID: PMC5767623 DOI: 10.15537/smj.2017.11.21033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[No Abstract Available].
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Affiliation(s)
- Mahmood D Al-Mendalawi
- Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq. E-mail.
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17
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Wells M, Goldstein LN, Bentley A, Basnett S, Monteith I. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis. Resuscitation 2017; 121:9-33. [PMID: 28958796 DOI: 10.1016/j.resuscitation.2017.09.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/31/2017] [Accepted: 09/23/2017] [Indexed: 11/28/2022]
Abstract
AIMS The Broselow tape is widely used as a weight-estimation device and drug-dosing guide aid, but concerns about its accuracy and its efficacy have emerged in the last decade. The aim of this study was to systematically review the literature to analyse the accuracy of the Broselow tape as a weight estimation device and review evidence of its utility as a drug-dosing guide. METHODS This was a MOOSE-driven systematic review and meta-analysis, which focused on studies evaluating the accuracy of the Broselow tape and studies reviewing its use as a drug-dosing aid. MAIN RESULTS The tape has undergone substantial changes over the years, but there was no evidence to show that the changes have improved weight-estimation performance. The weight-estimation accuracy of the tape was suboptimal in all populations, with just over 50% of children receiving an estimation within 10% of their actual weight. The overestimation of weight in low- and middle-income countries was often extreme. This indicated a significant potential for potentially harmful medication errors. The limited available evidence on the value of the tape as a drug-dosing guide indicated that the tape was frequently used incorrectly and contained insufficient information to function without additional resources. CONCLUSIONS The Broselow tape lacked sufficient accuracy as a weight estimation and drug-dosing tool when compared to other available techniques. In addition, the Broselow tape contains insufficient drug-dosing information to function as a complete resuscitation aid without additional material. The frequent rate of incorrect usage of the tape indicated that appropriate training with the tape is mandatory to reduce errors.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Alison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Sian Basnett
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Iain Monteith
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
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A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries. Afr J Emerg Med 2017; 7:S36-S54. [PMID: 30505673 PMCID: PMC6246873 DOI: 10.1016/j.afjem.2017.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction When weight cannot be measured during the management of medical emergencies in children, a convenient, quick and accurate method of weight estimation is required, as many drug doses and other interventions are based on body weight. Many weight estimation methodologies in current use have been shown to be inaccurate, especially in low- and middle-income countries with a high prevalence of underweight children. This meta-analysis evaluated the accuracy of weight estimation systems in children from studies from low- and middle-income countries. Methods Articles from low- and middle-income countries were screened for inclusion to evaluate and compare the accuracy of existing systems and the newer dual length- and habitus-based methods, using standard meta-analysis techniques. Results The 2D systems and parental estimates performed best overall. The PAWPER tape, parental estimates, the Wozniak method and the Mercy method were the most accurate systems with percentage of weight estimates within 10% of actual weight (PW10) accuracies of 86.9%, 80.4%, 72.1% and 71.4% respectively. The Broselow tape (PW10 47.1%) achieved a moderate accuracy and age-based estimates a very low accuracy (PW10 11.8–47.5%). Conclusions The PAWPER tape, the Wozniak method and the Mercy method achieved an acceptable level of accuracy in studies from low- and middle-income countries and should preferentially be used and further advanced for clinical emergency medicine practice. Parental estimates may be considered if the regular caregiver of the child is present and a recent measured weight is known. The Broselow tape and age-based formulas should be abandoned in low- and middle-income country populations as they are potentially dangerously inaccurate.
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Wells M, Goldstein LN, Bentley A. The accuracy of emergency weight estimation systems in children-a systematic review and meta-analysis. Int J Emerg Med 2017; 10:29. [PMID: 28936627 PMCID: PMC5608658 DOI: 10.1186/s12245-017-0156-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/07/2017] [Indexed: 11/16/2022] Open
Abstract
The safe and effective administration of fluids and medications during the management of medical emergencies in children depends on an appropriately determined dose, based on body weight. Weight can often not be measured in these circumstances and a convenient, quick and accurate method of weight estimation is required. Most methods in current use are not accurate enough, but the newer length-based, habitus-modified (two-dimensional) systems have shown significantly higher accuracy. This meta-analysis evaluated the accuracy of weight estimation systems in children. Articles were screened for inclusion into two study arms: to determine an appropriate accuracy target for weight estimation systems; and to evaluate the accuracy of existing systems using standard meta-analysis techniques. There was no evidence found to support any specific goal of accuracy. Based on the findings of this study, a proposed minimum accuracy of 70% of estimations within 10% of actual weight (PW10 > 70%), and 95% within 20% of actual weight (PW20 > 95%) should be demonstrated by a weight estimation system before being considered to be accurate. In the meta-analysis, the two-dimensional systems performed best. The Mercy method (PW10 70.9%, PW20 95.3%), the PAWPER tape (PW10 78.0%, PW20 96.6%) and parental estimates (PW10 69.8%, PW20 87.1%) were the most accurate systems investigated, with the Broselow tape (PW10 55.6%, PW20 81.2%) achieving a lesser accuracy. Age-based estimates achieved a very low accuracy. Age- and length-based systems had a substantial difference in over- and underestimation of weight in high-income and low- and middle-income populations. A benchmark for minimum accuracy is recommended for weight estimation studies and a PW10 > 70% with PW20 > 95% is suggested. The Mercy method, the PAWPER tape and parental estimates were the most accurate weight estimation systems followed by length-based and age-based systems. The use of age-based formulas should be abandoned because of their poor accuracy.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa. .,, Postnet Suite 429, Private Bag X1510, Glenvista, 2058, South Africa.
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Alison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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Al-Busaidi AA, Jeyaseelan L, Al-Barwani HM. The Accuracy of the Broselow™ Pediatric Emergency Tape for Weight Estimation in an Omani Paediatric Population. Sultan Qaboos Univ Med J 2017; 17:e191-e195. [PMID: 28690891 DOI: 10.18295/squmj.2016.17.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/07/2016] [Accepted: 02/05/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the accuracy of the Broselow™ Pediatric Emergency Tape (BT) for estimating weight in an Omani paediatric population at a tertiary care hospital. METHODS This retrospective cross-sectional study was conducted during July 2015. The electronic medical records of Omani outpatients <14 years old attending the Sultan Qaboos University Hospital, Muscat, Oman, between July 2009 and June 2013 were reviewed for recorded height and weight data. The BT Version 2002A was used to predict weight based on actual height measurements. Predicted weight measurements were then compared with actual weight to determine the accuracy of the estimation. RESULTS A total of 3,339 children were included in the study, of which 43.5% were female and 56.5% were male. The mean age was 6.4 ± 3.1 years and the mean height was 93.2 ± 23.5 cm. The mean actual weight was 13.9 ± 6.7 kg while the mean BT-predicted weight was 14.4 ± 6.9 kg. The BT-predicted weight estimations correlated significantly with actual weight measurements (intraclass correlation coefficient: 0.97; P <0.001). A Bland-Altman analysis indicated that the BT performed well when estimating weight among Omani children, with an overestimation of only 0.5 kg for the entire cohort. CONCLUSION The BT was found to be an effective tool for estimating weight according to body length in an Omani paediatric population. It should therefore be considered for use in emergency situations when actual weight cannot be determined.
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Affiliation(s)
| | - Lakshmanan Jeyaseelan
- Department of Statistics & Health Information, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal M Al-Barwani
- Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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Wells M, Goldstein LN, Bentley A. It is time to abandon age-based emergency weight estimation in children! A failed validation of 20 different age-based formulas. Resuscitation 2017; 116:73-83. [PMID: 28522127 DOI: 10.1016/j.resuscitation.2017.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/26/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
AIM When children's weight cannot be measured during medical emergencies, it must be estimated, as weight is required for many interventions. Age-based formulas are the oldest weight estimation systems in children, but have been shown to be very inaccurate in many studies. This aim of this study was to evaluate the accuracy of age- and length-based formulas and to see if a measure of body habitus could be used to improve the performance of these formulas. METHODS This was an analysis of data from a sample of 1085 children aged from 1 month to 16 years, collected from four Emergency Departments in Johannesburg, South Africa. Basic demographic and anthropometric data was collected and each child had a visual assessment of body habitus, quantified as a habitus score. Weight estimates from 20 existing age-based formulas and two length-based formulas were then compared against measured weight to determine their accuracy. Age- and length-based, habitus-modified models were developed and similarly evaluated.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Allison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
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Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e31. [PMID: 28148473 PMCID: PMC5311423 DOI: 10.2196/jmir.7005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods. Conclusions In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- Department of Health and Community Medicine, Division of Clinical Epidemiology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Oliver Sanchez
- Department of Pediatric Surgery, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
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Young KD, Korotzer NC. Weight Estimation Methods in Children: A Systematic Review. Ann Emerg Med 2016; 68:441-451.e10. [DOI: 10.1016/j.annemergmed.2016.02.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 01/08/2023]
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