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Knudsen-Robbins C, Pham PK, Zaky K, Brukman S, Schultz C, Hecht C, Bacon K, Wickens M, Heyming T. Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation. Prehosp Disaster Med 2022; 37:616-624. [PMID: 36098467 PMCID: PMC9470517 DOI: 10.1017/s1049023x22001248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined. STUDY OBJECTIVE The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation. METHODS This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care children's hospital from January 1, 2021 through June 30, 2021. Demographic data, ED visit information, prehospital weight estimation, and medication dosing were collected and analyzed. Scale-based weight from the ED was used as the standard for comparison. RESULTS A total of 509 patients <13 years of age were included in this study. The EMS providers using the Broselow method estimated patient weight to within +/-10% of ED scale weight in 51.3% of patients. When using the Handtevy method, the EMS providers estimated patient weight to within +/-10% of ED scale weight in 43.7% of patients. When comparing the Handtevy versus Broselow method of prehospital weight estimation, there was no significant association between method and categorized weight discrepancy (over, under, or accurate estimates - defined as within 10% of ED scale weight; P = .25) or percent weight discrepancy (P = .75). On average, prehospital weight estimation was 6.33% lower than ED weight with use of the Handtevy method and 6.94% lower with use of the Broselow method. CONCLUSION This study demonstrated no statistically significant difference between the use of the Handtevy or Broselow methods with respect to prehospital weight estimation. While further research is necessary, these results suggest similar field performance of the Broselow and Handtevy methods.
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Affiliation(s)
| | - Phung K. Pham
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, CaliforniaUSA
| | - Kim Zaky
- Department of Emergency Medicine, Children’s Health of Orange County, Orange, CaliforniaUSA
| | - Shelley Brukman
- Department of Emergency Medicine, Children’s Health of Orange County, Orange, CaliforniaUSA
| | - Carl Schultz
- Orange County Health Care Agency, Santa Ana, CaliforniaUSA
| | - Claus Hecht
- Orange County Fire Authority, Irvine, CaliforniaUSA
| | - Kellie Bacon
- Department of Emergency Medicine, Children’s Health of Orange County, Orange, CaliforniaUSA
| | - Maxwell Wickens
- Department of Emergency Medicine, Children’s Health of Orange County, Orange, CaliforniaUSA
| | - Theodore Heyming
- Department of Emergency Medicine, Children’s Health of Orange County, Orange, CaliforniaUSA
- Department of Emergency Medicine, University of California, Irvine, CaliforniaUSA
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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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Yakubu RC, Nguah SB, Ayi-bisah N. Comparison of paediatric weight estimation methods at a tertiary hospital in Ghana. Afr J Emerg Med 2021; 11:252-257. [PMID: 33859928 PMCID: PMC8027529 DOI: 10.1016/j.afjem.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Weight estimation in children is critical in paediatric emergencies. The Broselow Tape (BT) and most age-based formulae for weight estimation were derived in high-income countries and are thought to overestimate the weight of children in low-income countries. This study sought to validate the 2017 BT, and eight age-based weight estimation formulae among Ghanaian children and to derive a weight estimation formula using this data. Methods A cross-sectional study was conducted in the Tamale Teaching Hospital (TTH) in Ghana. Children aged between 2 months and 13 years had their weights estimated by the 2017 BT and eight age-based formulae. These estimated weights were compared to the weight of the children measured by a calibrated Seca scale using mean percentage error (MPE) and the percentage of weight estimates within 10% and 20% of actual weight. Bland-Altman method was used to assess agreement between estimated and actual weight of the children. A new formula was derived by linear regression. Results Seven hundred and seventy-five children took part in the study. The 2017 BT, Original APLS (APLS1) and Nelson's formulae performed best with proportion of weight estimates within 10% of actual weight being 47.5%, 51.1% and 47.5% respectively. The formula developed in this study was: WE = 3Am / 10 + 5 (for infants <12 months), WE = 2A + 7 (1 to 4 years) and WE = 2A + 9 (5 to 13 years), where WE is estimated weight, Am is age in completed months and A is age in completed years. The new formula had similar accuracy as the three best performing methods in this study. Conclusion The Broselow Tape, APLS1 and the Nelson's formula were the most accurate in this study. APLS1 and the Broselow Tape can be used for weight estimation in Ghanaian children when no other better method is available.
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Affiliation(s)
- Rafiuk Cosmos Yakubu
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Tamale Teaching Hospital, Tamale, Ghana
- Corresponding author at: Tamale, West Africa, Ghana.
| | - Samuel Blay Nguah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, School of Medicine and Dentistry, Kumasi, Ghana
| | - Nedda Ayi-bisah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Tamale Teaching Hospital, Tamale, Ghana
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Wu MT, Wells M. Pediatric weight estimation: validation of the PAWPER XL tape and the PAWPER XL tape mid-arm circumference method in a South African hospital. Clin Exp Emerg Med 2021; 7:290-301. [PMID: 33440107 PMCID: PMC7808830 DOI: 10.15441/ceem.19.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The primary aim of this study was to prospectively compare the performance of the Broselow tape, Mercy method, pediatric advanced weight prediction in the emergency room extra-long (PAWPER XL) tape, and PAWPER XL mid-arm circumference (MAC) method in estimating the weight of children from a low-income setting. The secondary aim was to analyze the time taken to perform each method. Methods This analyzed a convenience study sample of 300 children aged 0 to 18 years at the Baragwanath Hospital in South Africa. Weight estimations were obtained using each of the weight estimation systems on each child. These weight estimations were then compared against the actual weight to determine bias, precision, and accuracy of the estimation methods. Results The PAWPER XL tape and PAWPER XL-MAC methods performed the best and provided estimated weights within 10% of the actual weight in 62.7% and 67.3% of cases, respectively, followed by the Mercy method (56.5%) and Broselow tape (43.9%). The use of MAC improved the accuracy of estimation, especially in heavier and taller children. The median times taken to perform measurements using the Broselow tape, Mercy method, PAWPER XL tape, and PAWPER XL-MAC method were 11.3 seconds, 34.7 seconds, 9.3 seconds, and 33.9 seconds respectively. Conclusion The PAWPER XL tape and PAWPER XL-MAC methods were the most accurate methods of estimating weight in this group of children. These methods may be considered in preference to the Broselow tape or the Mercy method for emergency weight estimation in low socioeconomic status populations.
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Affiliation(s)
- Ming-Tung Wu
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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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Cattermole GN, Manirafasha A. Accuracy of weight estimation methods in adults, adolescents and children: a prospective study. Emerg Med J 2020; 38:718-723. [PMID: 32943398 DOI: 10.1136/emermed-2020-209581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Weight estimation of both adult and paediatric patients is often necessary in emergency or low-resource settings when it is not possible to weigh the patient. There are many methods for paediatric weight estimation, but no standard methods for adults. PAWPER and Mercy tapes are used in children, but have not been assessed in adults. The primary aim of this study was to assess weight estimation methods in patients of all ages. METHODS Patients were prospectively recruited from emergency and outpatient departments in Kigali, Rwanda. Participants (or guardians) were asked to estimate weight. Investigators collected weight, height, mid-arm circumference (MAC) and humeral-length data. In all participants, estimates of weight were calculated from height and MAC (PAWPER methods), MAC and humeral length (Mercy method). In children, Broselow measurements and age-based formulae were also used. The primary outcome measure was the proportion of estimates within 20% of actual weight (p20). RESULTS We recruited 947 participants: 307 children, 309 adolescents and 331 adults. For p20, the best methods were: in children, guardian estimate (90.2%) and PAWPER XL-MAC (89.3%); in adolescents, PAWPER XL-MAC (91.3%) and guardian estimate (90.9%); in adults, participant estimate (98.5%) and PAWPER XL-MAC (83.7%). In all age groups, there was a trend of decreasing weight estimation with increasing actual weight. CONCLUSION This prospective study of weight estimation methods across all age groups is the first adult study of PAWPER and Mercy methods. In children, age-based rules performed poorly. In patients of all ages, the PAWPER XL-MAC and guardian/participant estimates of weight were the most reliable and we would recommend their use in this setting.
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Affiliation(s)
- Giles N Cattermole
- Department of Anaesthesia, Critical Care and Emergency Medicine, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda .,Emergency Department, Princess Royal University Hospital, Orpington, UK
| | - Appolinaire Manirafasha
- Department of Anaesthesia, Critical Care and Emergency Medicine, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.,Emergency Department, King Faisal Hospital, Kigali, Rwanda
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Abstract
OBJECTIVES Obtaining accurate pediatric weight is necessary during emergency resuscitation. Although several weight estimation methods exist, the most precise method has not been conclusively determined. This study aimed to evaluate the validity, reliability, and practicality of these tools. METHODS A prospective observational study was conducted in healthy Thai children aged 6 months to 12 years. Correlations between estimated and actual weights were tested. Validity was assessed by mean bias (estimated weight minus actual weight) and accuracy (10% error). Practicality was evaluated by time usage and data derived from user questionnaires. RESULTS Four hundred thirty participants with mean age of 6.7 years and mean weight of 26 kg were enrolled. A strong correlation between estimated weight and actual weight in all methods was demonstrated. Parental estimation was the most accurate tool in all age groups, with the lowest overall mean error (ME) of -0.83 kg and the highest accuracy of 88.7%. The Broselow tape was the second most accurate tool in ages younger than 1 year and 1-to-5-year age groups (ME = 0.23 and 0.50 kg; accuracy = 55.3% and 54.1%, respectively). The Mercy method was the second most accurate tool in the 6-to-10-year and 11-to-12-year age groups (ME = -2.47 and -2.77; accuracy = 54.6% and 67.9%, respectively). The Broselow tape had the highest score for practicality of use. CONCLUSIONS Parental estimation was the most accurate method in every age group. The next best alternative is the Broselow tape in children aged 5 years or younger and the Mercy method in children aged older than 5 years.
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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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Manirafasha A, Yi S, Cattermole GN. Estimating children's weight in a Rwandan emergency centre. Afr J Emerg Med 2018; 8:55-58. [PMID: 30456148 PMCID: PMC6223606 DOI: 10.1016/j.afjem.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/08/2017] [Accepted: 03/31/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Most drugs, fluids and ventilator settings depend on the weight of a paediatric patient. However, knowledge of the weight is often unavailable as the urgency of the situation may impede measurement. The most common methods for paediatric weight estimation are based on height or age. This study aimed to compare the accuracy of various weight estimation methods and to derive a dedicated age-based tool within a Rwandan setting. METHODS This was a retrospective study using age, weight and height data from randomly selected charts of Rwandan children, aged between one and ten years, who attended the paediatric emergency centre, Centre Hospitalier Universitaire de Kigali, Rwanda. Weights were estimated using four versions of the Broselow Tape and several age-based formulae. Linear regression was used to derive a new age-based weight estimation formula, the Rwanda Rule. Weight estimations were then compared with actual weight using Bland-Altman analysis, and the proportions of estimates within 10 and 20% of actual weight. RESULTS There were 327 children included in the study. The derived Rwanda Rule was: weight (kg) = [1.7 × age (years)] + 8. This formula and the original Advanced Paediatric Life Support formula (weight = [2 × age] + 8) performed similarly. Both were better than other age-based formulae (69% of estimates within 20% of actual weight). All editions of the Broselow Tape performed better than age-based rules. The 1998 version performed best with 84.8% of estimates within 20% of actual weight. DISCUSSION This study is the first to compare paediatric weight estimation methods in Rwanda. Locally, and until we have evidence from further research that other methods are superior, we would advise use of the 1998 Broselow Tape in children aged one to ten years old. Where the Broselow Tape is not available, the original Advanced Paediatric Life Support formula should be used.
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Affiliation(s)
| | - Sojung Yi
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Giles N. Cattermole
- Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
- Princess Royal University Hospital, Orpington BR6 8ND, UK
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ALSulaibikh AH, Al-Ojyan FI, Al-Mulhim KN, Alotaibi TS, Alqurashi FO, Almoaibed LF, ALwahhas MH, ALjumaan MA. The accuracy of Broselow pediatric emergency tape in estimating body weight of pediatric patients. Saudi Med J 2018; 38:798-803. [PMID: 28762431 PMCID: PMC5556295 DOI: 10.15537/smj.2017.8.19448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the accuracy of the Broselow tape on estimating body weights of selected Saudi children. Methods: This is prospective study of children aged 7 days to 13 years who attended the Emergency Department of King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Saudi Arabia, from June 2015 to September 2015. Only children <34 kg were enrolled for the study and children with triage categories I and II were eliminated to avoid delay in providing appropriate treatment in these circumstances. Results: The relationship between the actual and tape estimated body weights showed a correlation coefficient of 0.945 (p<0.001) for all children. When adjusting the correlation coefficient related to weight groups, the correlation coefficient was 0.911 (p<0.001) for children with body weights between 10 to 25 kg. Conclusion: The Broselow tape measurements do not provide satisfactory results for all children in the selected population, but do provide highly correlated measurements for those children with body weights between 10 and 25 kg.
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Affiliation(s)
- Amal H ALSulaibikh
- Emergency Medicine Department, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia. E-mail.
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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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Cattermole GN, Manirafasha A. The accuracy of Broselow pediatric emergency tape in estimating body weight of pediatric patients. Saudi Med J 2017; 38:1159-159. [PMID: 29114709 PMCID: PMC5767624 DOI: 10.15537/smj.2017.11.21075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Giles N Cattermole
- Emergency Medicine, King's College Hospital NHS Trust, London, United Kingdom. E-mail.
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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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Cattermole GN, Graham CA, Rainer TH. Mid-arm circumference can be used to estimate weight of adult and adolescent patients. Emerg Med J 2016; 34:231-236. [PMID: 27993936 PMCID: PMC5502250 DOI: 10.1136/emermed-2015-205623] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 10/29/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022]
Abstract
Objectives Many drug and fluid regimens in emergency medicine are weight dependent in adults, but no standard adult weight estimation tools exist. Paediatric weight is often estimated in emergency situations using methods based on age or height when direct measurement is not possible, and recently, methods based on mid-arm circumference (MAC) have also been developed. The aim of this study was to derive and validate an accurate MAC-based method for weight estimation for use in all age groups. Methods Data were obtained from the US National Health and Nutrition Examination Survey (NHANES). MAC-based methods of weight estimation were derived in 8498 subjects (5595 adults aged 16–80 years, 2903 children aged 1–15.9 years) from the NHANES 2011–2012 dataset, using linear regression. NHANES 2009–2010 was used for validation in 9022 subjects (6049 adults aged 16–79 years, 2973 children aged 1–15.9 years). Results A simplified method of MAC-based weight estimation was derived from linear regression equation: weight in kg=4×MAC (in cm)—50. On validation, results in children aged 1–10.9 years were poor. In adults and children aged 11–15.9 years, over 60%, 90% and 98% of estimates fell, respectively, within 10%, 20% and 30% of actual weights when using the simplified formula. Conclusions In this description of a method for estimating weight in adults, we have derived and validated a simplified formula that is at least as precise in adults and adolescents as commonly used paediatric weight estimation tools in children.
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Affiliation(s)
- Giles N Cattermole
- Emergency Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
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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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Jung JY, Kwak YH, Kim DK, Suh D, Chang I, Yoon C, Lee JC, Kim HC, Choi JY, Ahn H. An assessment of the accuracy of a novel weight estimation device for children. Emerg Med J 2016; 34:163-169. [PMID: 27633345 DOI: 10.1136/emermed-2016-205817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND We sought to validate the accuracy and assess the efficacy of a newly developed electronic weight estimation device (ie, the rolling tape) for paediatric weight estimation. METHODS We enrolled a convenience sample of children aged <17 years presenting to our emergency department who volunteered to participate in the study. The children's heights and weights were measured, and three researchers estimated these values using the rolling tape and Broselow tape at 5 min intervals. The weight estimates of researcher 1, researcher 2 and the Broselow tape were compared with measured values, and mean percentage error (MPE), root mean square error (RMSE) and percentage of estimates within 10% of the actual measured values were calculated. For 30 randomly selected subjects, we compared the time interval from the start of the measurement to the time that orders for epinephrine, defibrillation dose and instrument size could be given in a simulated arrest scenario. RESULTS We enrolled 906 children (median age 4.0 years). For researcher 1, researcher 2 and the Broselow tape, MPE values were 0.11% (RMSE 2.61 kg), 1.41% (RMSE, 2.61 kg) and 1.72% (RMSE 5.41 kg), respectively, and the percentages of children with predictions within 10% of their actual weight were 75.1%, 75.7% and 60.6%, respectively. In the 30 simulated cases, the mean time for measurement to ordering was significantly shorter (25.8 s vs 35.5 s, p<0.001) for the rolling tape compared with the Broselow tape method. CONCLUSIONS The rolling tape is a good weight estimation tool for children compared with other methods. The rolling tape method significantly decreased the time from weight estimation to orders for essential drug dose, instrument size and defibrillation dose for resuscitation.
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Affiliation(s)
- Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seong-Nam, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ikwan Chang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chiyul Yoon
- Interdisciplinary Programme of Bioengineering, Seoul National University Graduate School, Seoul, Korea
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Korea.,Institute of Medical and Biological Engineering, Medical Research Centre, Seoul National University, Seoul, Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.,Department of Biomedical Engineering, Seoul National University Hospital, Seoul, Korea.,Institute of Medical and Biological Engineering, Medical Research Centre, Seoul National University, Seoul, Korea
| | - Jae Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Centre, Incheon, Korea
| | - HeeJeong Ahn
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Young TP, Washington O, Flanery A, Guptill M, Reibling ET, Brown L, Barcega B. Comparison of the finger counting method, the Broselow tape and common weight estimation formulae in Filipino children after Typhoon Haiyan. Emerg Med Australas 2015; 27:239-44. [PMID: 25818595 DOI: 10.1111/1742-6723.12382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We sought to evaluate commonly used paediatric weight estimation techniques in a sample of children in the Philippines. METHODS We prospectively collected age, height and weight data for a sample of 207 children aged 1-9 years seen during a medical aid trip. Weights were estimated using the finger counting method, the Broselow method and four formulae. Bland-Altman analysis was performed to evaluate agreement with measured weight. RESULTS Mean difference and range of agreement in kilograms were as follows: 0.6 (95% CI 0.1-1.1) and 14.9 (95% CI 13.1-16.7) for the Broselow method; 1.1 (95% CI 0.5-1.7) and 17.3 (95% CI 15.2-19.3) for the traditional APLS formula; 3.1 (95% CI 2.4-3.7) and 18.6 (95% CI 16.4-20.8) for the finger counting method; 4.0 (95% CI 3.2-4.8) and 23.1 (95% CI 20.3-25.8) for the updated APLS method; 5.1 (95% CI 4.4-5.8) and 21.1 (95% CI 18.6-23.6) for the Luscombe formula; and 5.3 (95% CI 4.5-6.1) and 22.5 (95% CI 20-25.2) for the Best Guess formulae. CONCLUSIONS The Broselow tape and the traditional APLS formula performed best in our sample. The finger counting method also outperformed newer weight estimation formulae. 'Updated' age-based formulae created recently in developed countries should not be used in disaster relief efforts in the Philippines. Caution should be used when applying these formulae to other developing countries and in disaster response.
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Affiliation(s)
- Timothy P Young
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
| | - Omar Washington
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
| | - Andrew Flanery
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
| | - Mindi Guptill
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
| | - Ellen T Reibling
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
| | - Lance Brown
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
| | - Besh Barcega
- Division of Paediatric Emergency Medicine, Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA
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Le Doare K, Barker CIS, Irwin A, Sharland M. Improving antibiotic prescribing for children in the resource-poor setting. Br J Clin Pharmacol 2015; 79:446-55. [PMID: 24433393 PMCID: PMC4345955 DOI: 10.1111/bcp.12320] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 01/08/2014] [Indexed: 12/30/2022] Open
Abstract
Antibiotics are a critically important part of paediatric medical care in low- and middle-income countries (LMICs), where infectious diseases are the leading cause of child mortality. The World Health Organization estimates that >50% of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients do not take their medicines correctly. Given the rising prevalence of antimicrobial resistance globally, inappropriate antibiotic use is of international concern, and countries struggle to implement basic policies promoting rational antibiotic use. Many barriers to rational paediatric prescribing in LMICs persist. The World Health Organization initiatives, such as 'Make medicines child size', the Model List of Essential Medicines for Children and the Model Formulary for Children, have been significant steps forward. Continued strategies to improve access to appropriate drugs and formulations, in conjunction with improved evidence-based clinical guidelines and dosing recommendations, are essential to the success of such initiatives on both a national and an international level. This paper provides an overview of these issues and considers future developments that may improve LMIC antibiotic prescribing.
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Affiliation(s)
- Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St George's University of LondonCranmer Terrace, London, SW17 0RE, UK
- Wellcome Trust Centre for Global Health Research, Imperial CollegeNorfolk Place, London, W2 1NY, UK
| | - Charlotte I S Barker
- Paediatric Infectious Diseases Research Group, St George's University of LondonCranmer Terrace, London, SW17 0RE, UK
- Wellcome Trust Centre for Global Health Research, Imperial CollegeNorfolk Place, London, W2 1NY, UK
| | - Adam Irwin
- Paediatric Infectious Diseases Research Group, St George's University of LondonCranmer Terrace, London, SW17 0RE, UK
- Wellcome Trust Centre for Global Health Research, Imperial CollegeNorfolk Place, London, W2 1NY, UK
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, St George's University of LondonCranmer Terrace, London, SW17 0RE, UK
- Wellcome Trust Centre for Global Health Research, Imperial CollegeNorfolk Place, London, W2 1NY, UK
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Young TP, Chen BG, Kim TY, Thorp AW, Brown L. Finger counting: an alternative method for estimating pediatric weights. Am J Emerg Med 2014; 32:243-7. [DOI: 10.1016/j.ajem.2013.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/13/2013] [Accepted: 11/17/2013] [Indexed: 12/01/2022] Open
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