Comparing the usability of paediatric weight estimation methods: a simulation study

Prescribing in a paediatric emergency: A PERUKI survey of prescribing and resuscitation aids

AIM

The aim was to investigate the use of paper-based and electronic prescribing and resuscitation aids in paediatric emergency care from a departmental and individual physician perspective.

METHODS

A two-stage web-based self-report questionnaire was performed. In stage (i), a lead investigator at PERUKI sites completed a department-level survey; in stage (ii), individual physicians recorded their personal practice.

RESULTS

The site survey was completed by 46/54 (85%) of PERUKI sites. 198 physicians completed the individual physicians' survey. Individual physicians selected the use of formulary apps for checking of medication dosages nearly as often as hardcopy formularies. The APLS WETFLAG calculation and hardcopy aids were widely accepted in both surveys. A third of sites accepted and half of the individual physicians selected resuscitation apps on the personal mobile device as paediatric resuscitation aids.

CONCLUSION

Our survey shows a high penetrance of the British National Formulary app, a success of NHS digital policy and strategy. Despite potential advantages, many physicians in our survey do not use resuscitation apps. Reluctance to engage with apps is likely to be multifactorial and includes human factors. These obstacles need to be overcome to create a digital healthcare culture.

How and Why Paediatric Weight Estimation Systems Fail - A Body Composition Study

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.

Are "virtual" paediatric weight estimation studies valid?

Introduction

“Virtual” studies account for nearly one-third of all published weight estimation articles, but the validity of these virtual studies has never been evaluated. It is important to establish this validity in order to decide whether the results of these studies can be applied to real-world usage. The objectives of this study were to evaluate the accuracy of virtual weight estimates using the Broselow and PAWPER tapes and compare these to actual real-life estimates from the tapes.

Methods

Virtual weights were generated for the Broselow and PAWPER tapes using anthropometric data from a sample of 1385 children for whom actual Broselow and PAWPER tape weights were available. The accuracy of the virtual and real-life estimates was compared against each child’s actual weight. The agreement of the virtual and real estimates was also evaluated.

Results

The percentage of weight estimates within 10% of actual weight were 57.9% and 59.3% for the real and virtual Broselow tapes respectively and 76.6% and 78.4% for the real and virtual PAWPER tapes respectively. The Cohen’s kappa for the real and virtual Broselow and PAWPER tapes was 0.65 and 0.64 respectively, which indicated substantial agreement.

Conclusions

The virtual and real weight estimates had very similar accuracy outcomes for both tapes in this study. However, if virtual studies are used, they should be followed by real-life studies in order to assess the impact of human and patient factor errors on the accuracy of the weight estimation systems.