The Accuracy of Broselow Tape Weight Estimate among Pediatric Population

Validity of Broselow tape for estimating the weight of children in pediatric emergency: A cross-sectional study

OBJECTIVE

To assess the validity of the Broselow tape in estimating the weight of Chinese children in pediatric emergency.

METHODS

A cross-sectional study was conducted in the emergency department of the Children's Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province, China) in March 2022. Broselow tape was used to estimate weight and its validity was compared with the advanced child life support (APLS) method.

RESULTS

The study included 442 children (mean age: 48 months; male-to-female ratio: 1.13:1). The < 10, 10-19 and > 19-kg groups included 44, 257, and 141 children, respectively. The color concordance rates of the Broselow tape-estimated weight in the three groups were 56.8, 57.2, and 68.1%, respectively. The percentage of weight estimations within 10% of actual weight were 65.8% (59.1, 65.8, and 68.1% for the <10, 10-19 and > 19-kg groups, respectively) and 44.8% (40.9, 50.6, and 35.5% for the < 10, 10-19 and > 19-kg groups, respectively) using the Broselow tape and the APLS method, respectively. The correlation between the Broselow tape estimated weight and actual weight was r = 0.931 (P < 0.0001, 95% CI: 0.918-0.943), while the correlation between actual weight and the APLS method calculated weight was r = 0.883 (P < 0.0001, 95% CI: 0.861-0.902). The mean percentage error using the Broselow tape was 1.0 ± 12.0% (P < 0.001 vs. -7.2 ± 17.2% of the APLS method).

CONCLUSION

The Broselow tape may be an available method for predicting the weights of Chinese children in pediatric emergency.

Non-Pediatric Nurses' Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

OBJECTIVE

To assess non-pediatric nurses' willingness to provide care to pediatric patients during a mass casualty event (MCE).

METHODS

Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses' willingness to provide MCE pediatric care.

RESULTS

In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital.

CONCLUSION

Pediatric surge capacity is lacking among nurses. Increasing nurses' pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

Validation of two pediatric resuscitation tapes

OBJECTIVE

This study aims to compare the actual weights of Filipino children with their estimated weights obtained from the Broselow tape and the Pediatric Advanced Weight Prediction in the Emergency Room eXtra Length-Mid-arm Circumference (PAWPER XL-MAC) tape.

METHODS

A prospective, observational, cross-sectional study conducted among Filipino children admitted at the Pediatric Emergency Department (ED) of The Medical City in Pasig City, Philippines. Mean percentage error (MPE) determined bias. Modified Bland-Altman analysis was used to perform a visual comparison of the bias and extent of agreement. The proportion of weight estimates within 10% (p 10) and within 20% (p 20) of actual weight was calculated to determine the overall accuracy.

RESULTS

A total of 220 Filipino children (63.2% male) were recruited. Both the Broselow and PAWPER XL-MAC tapes overestimate the actual weight by an average of 0.4% (95% limit of agreement [LOA] -29.4 to 30.2) and 1.3% (95% LOA -15.3 to 17.9) respectively. Across body mass index (BMI) groups, both tapes overestimate (MPE: +19.2 and +9.3) weight among underweight children and underestimate (MPE: -13.2 and -3.5; MPE: -18.6 and -5.5) weight among overweight and obese children. In measuring estimated weight within 10% and 20% of actual weight, the PAWPER XL-MAC performed best (79.6% and 96.8%).

CONCLUSION

The PAWPER XL-MAC tape performed better as a weight estimation tool compared to Broselow tape across different age groups and BMI-for-age groups of Filipino children. Both tapes tend to overestimate weight among younger and underweight children while underestimating weight among ages 7 to 10 years old, overweight, or obese children.

Accuracy of Critical Care Transport Team Estimation of Patient Height and Weight in Scene Responses

Estimates of clinically relevant information, such as height, weight, blood loss, and burn area, have consistently been fraught with error in the health care setting. Seemingly little has been done in health care education to improve estimate outcomes. Standardized tools, most often in pediatric populations, have become commonplace to guide acute care management when misestimation of data points like height or weight would likely have its biggest impact on patient care and outcome. This article is a retrospective study of a critical care transport team's abilities to estimate patient height and weight in scene responses using the Glasgow Coma Scale score as an indicator for the likelihood of patient input. Ultimately, height was removed as a variable because of the paucity and unreliability of the collected data. The expected outcome with respect to weight estimates was observed; with decreased patient Glasgow Coma Scale scores, the discrepancy in provider estimate increased from 8% to 12%. Although statistically significant, it does not represent the level of aberrancy noted in other studies, which has been reported to be as high as 40%.

Comparison of weight estimation methods in hospitalized Brazilian children and adolescents

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.

Accuracy of Broselow tape in estimating the weight of the child for management of pediatric emergencies in Nepalese population

Background

Children with emergency conditions require immediate life-saving intervention and resuscitation. Unlike adults, the pediatric emergency drug dose, equipment sizes, and defibrillation energy doses are calculated based on the weight of the individual child. Broselow tape is a color-coded length-based tape that utilizes height/weight correlations for children. However, in low-income countries like Nepal, due to factors like undernutrition, the Broselow tape may not accurately estimate weight in all ranges of pediatric age group.

Methods

This study was conducted in the Department of Pediatrics of Dhulikhel Hospital, Kathmandu University Teaching Hospital, in children less than 15 years of age. Our study aims to prospectively compare the actual weights of urban and rural Nepalese children with the estimated weights using the Broselow tape (2017 edition) and the updated APLS formula. The errors in the selection of endotracheal tube size and adrenaline dose using the Broselow tape were also explored.

Results

This study included 315 children with male to female ratio of 0.63:1. They were divided into 3 groups according to their estimated weight by the Broselow tape into < 10 kg, 10–18, and > 18 kg. There was a total agreement of the estimated color zone according to the Broselow tape with the actual weight in the gray zone (p = 0.01). There was a positive relationship between the actual body weight and the estimated body weight (correlation (r = 0.970, p = 0.01) and accuracy (r² = 0.941)). Our analysis showed that the accuracy of estimated weight with the Broselow tape decreases with increasing weight of children. The precision of the tape was relatively high in the lower length zones as compared to the higher length zones. The estimated size of the endotracheal tube (p = 0.01) and adrenaline dose (p = 0.08) by the Broselow tape was in agreement with that estimated using PALS formula in weight group of less than 18 kg, but decreases as the estimated weight increases further.

Conclusions

The accuracy of the Broselow tape in estimating the weight of a child, endotracheal tube size, and dose of adrenaline is higher in weight group of less than 18 kg, and accuracy decreases as the weight of child increases. The Broselow tape should be avoided in children weighing more than 18 kg. Hence, PALS age-based formula for ET tube size estimation and weight-based formula for adrenaline dose calculation are recommended for children weighing more than 18 kg.

Weight estimation in Paediatrics: how accurate is the Broselow-tape weight estimation in the Nigerian child

Background

Determination of weight in children is an important aspect of their assessment. It has a wide range of usefulness including assessing their nutritional status and drug dose calculation. Despite its usefulness, weight estimation in children in certain conditions can be challenging particularly in emergency situations or in children who are severely ill or cannot stand on standard scales. The Broselow Tape which is a validated tape that is used to estimate weight based on length was developed using height/weight correlations from Western data. However, considering the variations in anthropometric measurements of children from different geographic locations, there is need to ascertain how accurate it is to estimate weight using the Broselow tape among children in Nigeria.

Aim

The study was carried out to determine the accuracy in the use of the Broselow Tape in weight estimation among Nigerian children.

Method

A total 1456 children aged 1–12 years who satisfied the inclusion criteria were enrolled over a 2½ year period from two tertiary health facilities in Enugu state Nigeria. Weight was taken using standard weighing scale and Broselow tape. Data collected was analysed using SPSS.

Result

Of the 1456 children studied, majority (84.2%) had normal Body-Mass-Index (BMI) while about 4.6% had a low BMI percentile for age. The mean weight difference between the two methods was not significantly different between the 1 to 6 years old category. Significant differences were observed from 7 up to 12 years. The Broselow Tape overestimated weights in 1 year old by 3.88%, 2 years 1.58%, 3 years by 2.13%, 4 years (1.94%) and 5 year (0.07%). After 5 years, the degree of overestimation rises sharply to 4.25% in 6, 9.25% in 7, 7.29% in 8 and 9.29%. 9.18, 11.61% & 6.75% in 9, 10, 11 and 12 years old respectively. The proportion of estimated weights that was within 10- 20% of the actual weight was higher in the 1-6 years age categories compared to weight estimates in older age categories.

Conclusion

Weight estimates obtained using the Broselow tape correlated better in children that are 6 years or younger compared to those in the older age categories. There is need for re-validation and/or adjustments of the Broselow tape especially in children over 6 years old.

The accuracy of Broselow pediatric emergency tape in estimating body weight of pediatric patients

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.

The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis

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.

A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries

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.

The accuracy of emergency weight estimation systems in children-a systematic review and meta-analysis

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.

The Accuracy of the Broselow™ Pediatric Emergency Tape for Weight Estimation in an Omani Paediatric Population

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.