Utility of Body Habitus Parameters to Determine and Improve the Accuracy of the Broselow Tape

OBJECTIVES

The aims of this study were to determine and improve accuracy of the Broselow Tape (BT) in estimating children's weight by adding body habitus parameters.

METHODS

This cross-sectional study was conducted in an urban hospital pediatric clinic. Children up to 8 years old coming in for well-child visit were included. Children with acute illness or presence of any chronic condition potentially resulting in growth disturbance and out of BT height range were excluded. The following body habitus parameters were measured using the Centers for Disease Control and Prevention guidelines: actual weight, predicted weight using BT (BTW), mid-thigh circumference (MTC), body mass index, mid-arm circumference, and waist-to-hip ratio.

RESULTS

A total of 301 children were enrolled. Of these, 151 were male (50%). Hispanics constituted 160 (53.2%). There was a positive linear association between BTW and actual weight in the overall cohort (adjusted R2 = 0.9164, P < 0.001). However, there was a difference in this association among children younger than 2 years and children older than 2 years (adjusted R2 = 0.89 vs 0.4841). Incorporating MTC and/or waist circumference along with BTW in the model increased the accuracy, providing a better estimate of actual weight (adjusted R2 = 0.94, P < 0.001).

CONCLUSIONS

We conclude that there might be inaccuracies in the weight predicted by BT in our patient population, especially those weighing more than 15 kg and older than 2 years. Our study also demonstrates that MTC correlates closely with the actual weight and could be used in addition to BT for more accurate weight estimation.

Roll up the tape? Laser and optical technologies improve paediatric weight estimation

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.

How Accurate Are Pediatric Emergency Tapes? A Comparison of 4 Emergency Tapes With Different Length-Based Weight Categorization

OBJECTIVE

Pediatric emergency tapes have been developed to support paramedics and emergency physicians when dosing drugs and selecting medical equipment in pediatric emergency situations. The aim of this study was to compare the accuracy of 4 pediatric emergency tapes to correctly estimate patient's weight based on a large population of patients.

METHODS

Patients undergoing general anesthesia between January 2012 and March 2015 with documented age, sex, body weight, and length were identified from the electronic anesthesia patient data management system of the Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. Weight estimation by means of the Broselow-Tape, the Pädiatrisches Notfalllineal, the Paulino System, and the Kinder-Sicher were compared with true patient's weight. Percentages of estimated body weight within a ±10% and ±20% interval were calculated. Data are median (interquartile range) or count (percent); statistical calculations were done with McNemar and Bonferroni correction.

RESULTS

A total of 3307 patients were identified with complete data sets, 1930 (58.4%) were male, median age was 4.1 years (1.1-8.2 years), median length 101.0 cm (74.0-126.0 cm) and median patient weight 15.8 kg (9.2-25.0 kg). The proportion weight estimation within the ±10% and the ±20% interval was the highest in the Broselow-Tape with 54.0% and 81.5% (P < 0.001 and P = 0.003), followed by the Pädiatrisches Notfalllineal (50.5% and 79.8%), Paulino System (49.9% and 78.0%) and Kinder-Sicher (48.2% and 77.5%).

CONCLUSIONS

The overall accuracy of all 4 emergency tapes tested is poor and including a larger number of weight categories does not necessarily increase accuracy. Other strategies have to be developed to improve weight estimation in pediatric emergency situations.

A Reexamination of the Accuracy of the Broselow Tape as an Instrument for Weight Estimation

BACKGROUND

Accurate weight estimation is important for calculating appropriate medication dosages, determining rates of fluid replacement, and selecting correct equipment sizes in critically ill children requiring resuscitation. The actual measurement of the weight of a critically ill or injured child is often not possible. The Broselow Pediatric Emergency Tape (BT) is an important tool for predicting a child's weight based on his/her height. Although BT has previously been validated, given the increasing prevalence of obesity in today's society, it behooves clinicians relying on this resuscitation aid to revisit the issue.

OBJECTIVE

The aim of this study was to evaluate the accuracy of the color-coded BT in weight estimation and the influence of obesity on its accuracy.

METHODS

This is a retrospective study conducted in a pediatric clinic of urban hospital. This study reviewed the medical records of children up to 96 months of age, who presented during 2008-2010. We recorded the child's age (in months), actual (measured) weight (in kilograms), and height (in centimeters). Based on the height, weight estimation was obtained using the color-coded BT. The actual weight was compared with the predicted weight obtained by the height-based BT. Patients presenting with any medical condition that would substantially affect growth of the child were excluded. A univariate logistic regression model was utilized to predict any underestimation based on age, sex, and body mass index (BMI) percentile.

RESULTS

The medical records of 538 children were reviewed. There was a discrepancy in 226 children (42%). Broselow Pediatric Emergency Tape underestimated weight (measured weight was higher than predicted weight) in 158 children (29.4%) and overestimated (measured weight was lower than predicted weight) in 68 children (12.6%). Of the 158 underestimated children, 138 were off by 1 color zone, 16 by 2 color zones, and 4 by more than 2 color zones. When characterized by BMI, 46 children (13.6%) had normal BMI, 27 (45.8%) were overweight, and 84 (80.8%) were obese, whereas one child (2.8%) was underweight.

CONCLUSIONS

In our population, BT was inaccurate in predicting weight in 42% of children (underestimation in 158 children [29.4%] and overestimation weight in 68 children [12.6%]). However, the majority of discrepancies involved only 1 BT color zone. Emergency physicians should be aware of this discrepancy until more accurate methods become available.

Validation of the mid-arm-based weight estimation formula (the Cattermole formula) for Korean children

BACKGROUND

A mid-arm circumference-based weight estimation formula has recently been proposed. The Cattermole formula, which is suggested for children aged 1-11 years, is calculated as (mid-arm circumference in cm - 10) × 3 kg. The objective of this study was to externally validate the Cattermole formula using a Korean national survey database.

METHODS

The data collected from a national survey conducted in 2005 by the Korean Pediatric Society included body weight, height, age and mid-arm circumference. To determine whether the Cattermole formula accurately predicted the actual weights of Korean children, we compared the performance of the Cattermole formula with those of other age-based and height-based weight estimation methods.

RESULTS

A total of 91,147 children aged 1-11 years were assessed for eligibility. The mean age was 5.3 years, and 52.6% of the children were boys. The mean measured weight was 22.4 kg, and the mean mid-arm circumference was 17.9 cm. The Cattermole formula resulted in a mean difference of 1.35 kg and a mean percentage error of 11.5% with 95% limits of agreement of -8.1 to +10.8. A total of 37.9% of the estimates were within 10% of the measured weights.

CONCLUSION

Across all ages, the Cattermole formula was not more accurate than the other methods. However, in children older than 6 years, the Cattermole formula results were more accurate than those of the age-based formulae with the exception of the Broselow tape.

CLINICAL TRIAL REGISTRATION

None.

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.

Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus

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.

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.

A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial

Background

During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion.

Objective

The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods.

Methods

The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection.

Results

A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods.

Conclusions

In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.

The RAMA Ped Card: Does it work for actual weight estimation in child patients at the emergency department

BACKGROUND

In emergency conditions, the actual weight of infants and young children are essential for treatments. The RAMATHIBODI Pediatric Emergency Drug Card or RAMA Ped Card has also been developed to estimate actual weight of the subjects. This study aimed to validate the RAMA Ped Card in correctly identifying the actual weight of infants and young adults.

METHODS

This study was a prospective study. We enrolled all consecutive patients under 15 years of age who visited the emergency department (ED). All eligible patients' actual weight and height were measured at the screening point of the ED. The weight of each patient was also measured using the unlabeled RAMA Ped Card. The Cohen's kappa values and agreement percentages were calculated.

RESULTS

During the study period, there were 345 eligible patients. The RAMA Ped Card had a 61.16% agreement with the actual weight with a kappa of 0.54 (P<0.01), while the agreement with the actual height had a kappa of 0.90 and 91.59% agreement. Sub-group analysis found kappa scores with good range in two categories: in cases of accidents and in the infant group (kappa of 0.68 and 0.65, respectively).

CONCLUSION

The RAMA Ped Card had a fair correlation with the actual weight in child patients presenting at the ED. Weight estimation in infant patients and children who presented with accidents were more accurate.

An assessment of the accuracy of a novel weight estimation device for children

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.

The Accuracy of Broselow Tape Weight Estimate among Pediatric Population

Objective. To determine the accuracy of the Broselow Tape (BT) versions 2007 and 2011 in estimating weight among pediatric population. Methods. A cross-sectional study was conducted at King Fahad Medical City and six schools across Riyadh province on 1-143-month-old children. BT 2007 and 2011 estimated weights were recorded. Both tapes via the child's height produce an estimated weight, which was compared with the actual weight. Results. A total of 3537 children were recruited. The height (cm) of the subjects was 97.7 ± 24.1 and the actual weight (kg) was 16.07 ± 8.9, whereas the estimated weight determined by BT 2007 was 15.87 ± 7.56 and by BT 2011 was 16.38 ± 7.95. Across all the five age groups, correlation between actual weight and BT 2007 ranged between 0.702 and 0.788, while correlation between actual weight and BT 2011 ranged between 0.698 and 0.788. Correlation between BT 2007 and BT 2011 across all the five age groups ranged from 0.979 to 0.989. Accuracy of both the tape versions was adversely affected when age was >95 months and body weight was >26 kilograms. Conclusions. Our study showed that BT 2007 and 2011 provided accurate estimation of the body weight based on measured body height. However, 2011 version provided more precise estimate for weight.

Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings

Importance

A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers.

Objective

To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries.

Design

This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992–2006 using a modified Expanded Program of Immunization two-stage cluster sample design.

Setting

Locations with high prevalence of acute and chronic malnutrition.

Participants

A total of 453,990 children met inclusion criteria (age 6–59 months; weight ≤ 25 kg; MUAC 80–200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values).

Exposures

Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined.

Main Outcomes and Measures

Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision.

Results

Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.15 kg; 2.24 kg). The height model fitted for MUAC classes was accurate and precise. For MUAC < 115 mm, the proportion of estimates accurate to within ± 25% of true weight was 97.15% (95% CI 96.90%, 97.42%) and the Bland-Altman bias and 95% limits of agreement were 0.08 kg and (-1.21 kg; 1.37 kg). For MUAC between 115 and 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.93% (95% CI 98.82%, 99.03%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-1.15 kg; 1.24 kg). For MUAC > 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.33% (95% CI 98.29%, 98.37%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.08 kg; 2.19 kg).

Conclusions and Relevance

Models estimating weight from height alone and height with MUAC class in children aged 6–59 months in a database from low-to-middle income countries were more accurate and precise than previous weight estimation tools. A height-based weight estimation tape stratified according to MUAC classes is proposed for children aged 6–59 months in limited-resource settings.

[New pediatric drug dosage aids. Improving patient safety]

Dosing errors when administering medicine to children occur often and are due, e.g., to the commonly required dilution of the drugs, misjudgment of the patient's weight, confusion between drugs with similar names, and inadequate communication. Various aids (e.g., measuring tapes and dilution tables) have been designed to avoid mistakes to the greatest extent possible. In daily clinical practice, books and pocket cards are still used for rapid orientation. Use of smartphone-based apps continues to increase, whereby the user is ultimately responsible for their validity. In clinical practice, the simplest possible strategies should be used. A culture that encourages disclosure of errors is useful in order to optimize processes and avoid future errors.

A Validation Study of the PAWPER (Pediatric Advanced Weight Prediction in the Emergency Room) Tape--A New Weight Estimation Tool

OBJECTIVE

To evaluate the performance of the PAWPER (Pediatric Advanced Weight Prediction in the Emergency Room) tape, a new weight-estimation tool with a modifier for body habitus, in our increasingly obese population.

STUDY DESIGN

A convenience sample of children presenting to the pediatric emergency department of an urban public hospital was enrolled. A nurse or doctor assigned the patient a body habitus score and used the PAWPER tape to estimate the weight. The true weight was then recorded for comparison.The estimated weight was considered accurate if it was within 10% of the true weight.

RESULTS

We enrolled 1698 patients; 579 (34%) were overweight or obese. Overall, the estimated weight was accurate for 64% of patients (95% CI 61%-65%). For children with an above-average body habitus, the tape was accurate 50% of the time (95% CI 46%-55%). There was no significant difference in the accuracy of the PAWPER tape for children assessed during medical and trauma resuscitations.

CONCLUSION

Although the PAWPER tape may ultimately be useful, its initial performance was not replicated in our population. A simple, accurate method of weight estimation remains elusive.

Convenience Sampling of Children Presenting to Hospital-Based Outpatient Clinics to Estimate Childhood Obesity Levels in Local Surroundings

Childhood obesity is a critical public health matter associated with numerous pediatric comorbidities. Local-level data are required to monitor obesity and to help administer prevention efforts when and where they are most needed. We hypothesized that samples of children visiting hospital clinics could provide representative local population estimates of childhood obesity using data from 2007 to 2013. Such data might provide more accurate, timely, and cost-effective obesity estimates than national surveys. Results revealed that our hospital-based sample could not serve as a population surrogate. Further research is needed to confirm this finding.

Comparison of the finger counting method, the Broselow tape and common weight estimation formulae in Filipino children after Typhoon Haiyan

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.

Use of the Broselow tape in a Mexican emergency department

BACKGROUND

The Broselow tape is one method for rapid weight estimation in pediatric patients undergoing resuscitation, but it does not perform equally in all populations. To date, we are unaware of any study evaluating its use in a Latin American population.

OBJECTIVE

To investigate the accuracy of the Broselow tape in a Mexican emergency department (ED).

METHODS

We conducted a prospective, observational study of children presenting to a Mexican ED. Patient weight was estimated using the Broselow tape and the estimate compared to their weight measured on a scale. Researchers were blinded to scale weight and Broselow categories. For analysis, the Broselow tape's nine color zones were divided into three weight categories.

RESULTS

Of 815 subjects, 356 (43.7%) were female. In children weighing <10 kg, the tape tended to underestimate weight, whereas it overestimated weight in the other two weight categories. The mean percentage difference between the actual weight and the Broselow tape-predicted weight was <3% in each category, although it differed significantly across the three weight categories. Accuracy of the predicted weight to within 10% of actual weight was lowest for children weighing <10 kg, at 46.2% (confidence interval [CI] ± 6.4%), and greatest for those in the 10-18-kg weight category, at 64.1% (CI ± 5.1%). However, the correlation of color zones predicted by both methods was highest for subjects <10 kg at 64.4% (CI ± 6.1%). It was significantly lower in the other weight categories at 54.5% (CI ± 5.3) for subjects weighing 10-18 kg, and 50.1% (CI ± 6.4%) for subjects weighing >18 kg. The percentage of children for whom the color code differed by two or more categories was <4% overall and for each weight category.

CONCLUSION

The Broselow tape-estimated weight was different from the scale weight by more than 10% in a substantial percentage of Mexican children. Nevertheless, the mean percentage difference was <3%, and Broselow tape color zone estimation was accurate in the majority of subjects, suggesting its use would result in clinically appropriate dosing and equipment estimations. Further research is needed to validate its use in this clinical setting.

Pediatric obesity and safety in inpatient settings: a systematic literature review

OBJECTIVE

Pediatric obesity affects more than 16% of American children and is associated with worse outcomes in hospitalized patients. A systematic literature review was performed to identify studies of adverse care events affecting obese pediatric patients in the emergency room, operating room, or inpatient wards.

EVIDENCE REVIEW

We systematically searched Medline for articles published from 1970 to 2013 regarding obesity and patient safety events in pediatric acute care settings. We determined the study design, number of patients studied, definition and prevalence of obesity, the relevant acute care setting, the specific association with obesity addressed, and the results of each study.

RESULTS AND CONCLUSION

Thirty-four studies documented both procedural complications and issues with general hospital care. Most were retrospective and focused on surgery or anesthesia. Obese patients may have increased risk for a variety of adverse events. Further study could improve institutional patient safety guidelines to enhance care for obese children.

Assessing the accuracy of common pediatric age-based weight estimation formulae

BACKGROUND

Many of the common equations for weight estimation in children were either introduced before the widespread prevalence of childhood obesity or have not been assessed in overweight/obese children. Therefore, we assessed the accuracy of 3 common age-based weight estimation formulae (Advanced Pediatric Life Support, Luscombe, and Theron) for predicting the weight of children undergoing elective, noncardiac operations. We also developed and validated a new age-based weight estimation formula.

METHODS

We used preoperative anthropometric and clinical data on 13,933 children aged 2 to 12 years to evaluate the performance of 3 pediatric age-based weight estimation formulae. Ability of the formulae to predict measured weights was assessed in a derivation cohort (75% randomly selected from the study sample). We also developed and validated a new age-based formula (the Michigan formula) that could be used to estimate the weight of contemporary American children.

RESULTS

Among the 10,488 children in the derivation cohort, 31.8% were overweight or obese while 55.7% were boys. The accuracy of the formulae varied considerably. The Luscombe formula demonstrated the lowest mean bias of 3.4 kg (95% confidence interval, 3.2-3.5 kg) and 89.7% of estimates within 10% of measured weight. Our derived linear regression equation the "Michigan Formula" demonstrated the highest accuracy compared with the existing formulae with a bias of 4.6 kg (95% confidence interval, = 4.36-4.84 kg) and 92% of estimates within 10% of measured weights.

CONCLUSIONS

Accuracies of current weight estimation formulae varied greatly. Our derived equation (Michigan formula: weight (kg) = 3 x age (yr) + 10) demonstrated high accuracy when compared with existing formulae and may be more applicable for estimating the weight of contemporary American children.

Pharmacotherapy of pediatric advanced life support and toxicological emergencies

Guidelines for pediatric advanced life support have been available for nearly a quarter of a century. Recommendations for the pharmacological management of pediatric cardiac arrest have changed over these years. Several important differences have been observed between adult advanced cardiac life support and pediatric advanced life support that must be recognized when children require resuscitation, such as the cause of the arrest, age-specific monitoring parameters, weight-based medication dosing, and obstacles in obtaining venous access. To make matters more complicated, differences also exist across neonatal and pediatric age spectrums. In addition, some toxicological emergencies commonly occurring in children require pharmacological management with agents that have a unique mechanism of action for cardiac support.

Estimating the weight of children in Kenya: do the Broselow tape and age-based formulas measure up?

STUDY OBJECTIVE

Validated methods for weight estimation of children are readily available in developed countries; however, their utility in developing countries with higher rates of malnutrition and infectious disease is unknown. The goal of this study is to determine the validity of a height-based estimate, the Broselow tape, compared with age-based estimations among pediatric patients in Western Kenya.

METHODS

A prospective cross-sectional study of all sick children presenting to the emergency department of a government referral hospital in Eldoret, Kenya, was performed. Measured weight was compared with predicted weights according to the Broselow tape and commonly used advanced pediatric life support (APLS) and Nelson's age-based formulas. A Bland-Altman analysis was used to determine agreement between each method and actual weight. The method for weight prediction was determined a priori to be equivalent to the actual weight if the 95% confidence interval for the mean percentage difference between the predicted and actual weight was less than 10%.

RESULTS

Nine hundred sixty-seven children were included in analysis. The overall mean percentage difference for the actual weight and Broselow predicted weight was -2.2%, whereas APLS and Nelson's predictions were -5.2% and -10.4%, respectively. The overall agreement between Broselow color zone and actual weight was 65.5%, with overestimate typically occurring by only 1 color zone.

CONCLUSION

The Broselow tape and APLS formula predict the weights of children in western Kenya. According to its better performance, ease of use, and provision of drug dosing and equipment size, the Broselow tape is superior to age-based formulas for estimation of weight in Kenyan children.