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Wells M, Yende P. Is there evidence that length-based tapes with precalculated drug doses increase the accuracy of drug dose calculations in children? A systematic review. Clin Exp Emerg Med 2024; 11:145-160. [PMID: 38018070 PMCID: PMC11237260 DOI: 10.15441/ceem.23.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The use of pediatric length-based weight estimation tapes with precalculated drug doses is advocated by major Advanced Life Support organizations, but concerns have been raised on the accuracy of these systems. The objective of this systematic review was to collect, review, evaluate, and create a synthesis of the current literature to establish whether there is high-quality evidence for use of length-based tapes in accurate drug dose administration. A further objective was to compare these tapes with other dosing aids. METHODS Eligible studies were identified and analyzed if they were peer reviewed, full text articles containing original data. Studies including any form of length-based precalculated drug dosing methodology in children aged 0 to 18 years were included. RESULTS Eighteen studies met the inclusion criteria. The most studied of the tapes was the Broselow tape in 16 studies (88.9%). When these tapes were used on their own without additional reference material, they produced a substantial number of potentially harmful dosing errors (>20% error). No tape was superior to another. Using the tapes was better than using no dosing aid but was inferior to using both comprehensive drug dosing guides and novel color-coded medication administration systems. CONCLUSION There was no high-quality evidence that the use of length-based tapes with precalculated drug doses leads to accurate drug dosing. However, comprehensive drug dosing systems were more effective at reducing dosing errors than were length-based tapes on their own. The confounding effect of weight estimation accuracy on drug dosing accuracy has not been sufficiently studied.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Penelope Yende
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Setlur K, Sankar J, Kapil U, Pandey RM, Kabra SK, Lodha R. Development and Validation of a Weight Estimation Tool for Acutely Ill Children Who Cannot be Weighed. Indian J Pediatr 2024; 91:344-350. [PMID: 37402105 DOI: 10.1007/s12098-023-04600-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/17/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES To develop and validate weight estimation tools using mid upper arm circumference (MUAC) and body length, and determine accuracy and precision of Broselow tape in children 6 mo to 15 y of age. METHODS Data of 18,456 children aged 6 mo to 5 y and 1420 children aged 5 to 15 y were used to develop linear regression equations using length and MUAC to estimate weight. These were validated on prospectively enrolled populations of 276 and 312 children, respectively. Accuracy was measured by Bland-Altman bias, median percentage errors, and percentage of predicted weight within 10% of true weight. Broselow tape was tested on the validation population. RESULTS Gender specific equations were developed which estimated weight within 10% of true weight in 69.9% (64.1-75.2%) and 65.7% (60.1-70.9%) of children aged 6 mo to 5 y, and 5 to 15 y, respectively. Broselow tape predicted weight within 10% of the true weight in 40.5% (34.7-46.6%) and 32.5% (26.7-38.7%) of children aged 6 mo to 5 y and 5 to 15 y, respectively. CONCLUSIONS The model developed from MUAC and length accurately estimated weight in children aged 6 mo to 15 y, and is potentially useful during emergencies. The Broselow tape frequently overestimated weight in authors' setting.
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Affiliation(s)
- Kritika Setlur
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Umesh Kapil
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Muacevic A, Adler JR, Francis J, Kumar M, Singha SK, Shukla A. Applicability of the Broselow Pediatric Emergency Tape to Predict the Size of Endotracheal Tube and Laryngeal Mask Airway in Pediatric Patients Undergoing Surgery: A Retrospective Analysis. Cureus 2023; 15:e33327. [PMID: 36741616 PMCID: PMC9894818 DOI: 10.7759/cureus.33327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/05/2023] Open
Abstract
Background This study aims to elucidate the applicability of the Broselow pediatric emergency tape in predicting the size of the endotracheal tube (ET) and laryngeal mask airway (LMA) in children of central India. Methods A retrospective review was conducted in the Department of Pediatric Surgery during the period of four years (January 2018 to December 2021), and all children between 1 month and 12 years of age who were admitted for routine surgery and were operated on were included. The goal was to assess the accuracy of Broselow pediatric emergency tape in predicting the size of ET and LMA in children and assess the applicability of this tape in an Indian setting based on observation and comparison with the predicted ET tube and LMA size based on the tape. The correlation was done between the predicted ET tube and LMA size and used ET tube and LMA size (the difference and mean). The Chi-square test was applied to test the difference between those matching and those not matching with their respective color zones with respect to weight, tracheal tube (LMA/ET) tube, and for both weight and tracheal tube, and then the p-value was calculated. A p-value of less than 0.05 was considered to be significant. Results A total of 296 patients were included in the study. There were 230 males and 66 females. A maximum number of patients were in the white zone (56 patients). A total of 112 patients (37.8%) matched the zone with their weight; 192 patients (64.8%) matched their LMA/ET tube with their respective zones; 81 patients (27.36%) matched both their weights and tracheal tube (LMA/ET) size with the predicted values as per their respective zones. Pearson's Chi-square test was applied to assess the significance of the difference between the number of patients matching and not matching their weight, LMA/ET tube, and both weight and LMA/ET tube with their corresponding color zones as per the Broselow tape. For all the above parameters, the differences were found to be not significant for p-value <0.05. Conclusions Broselow tape (BT) is applicable in acute trauma settings where it can be used for estimating weight and ET/LMA sizes in an emergency situation where weight measurement is not feasible.
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Lawson J. New Life and Tragic Loss: A Story of Resilience. J Emerg Nurs 2023; 49:5-7. [PMID: 36581391 DOI: 10.1016/j.jen.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 12/28/2022]
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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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Zhu S, Zhu J, Zhou H, Chen X, Liang J, Liu L, Zhang C, Zhao Y, Chen Y, Wu X, Ye S, Jiang K. Validity of Broselow tape for estimating the weight of children in pediatric emergency: A cross-sectional study. Front Pediatr 2022; 10:969016. [PMID: 36052355 PMCID: PMC9424914 DOI: 10.3389/fped.2022.969016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Shuzhen Zhu
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jihua Zhu
- Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongqin Zhou
- Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiuping Chen
- Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianfeng Liang
- Statistics Office, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijun Liu
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Caidi Zhang
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yingying Zhao
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanyan Chen
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Wu
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Ye
- Emergency Department, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kewen Jiang
- Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Children's Health and Diseases/National Regional Children's Medical Center, Hangzhou, China
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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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