Estimating the weight of children in Nepal by Broselow, PAWPER XL and Mercy method

Comparison of paediatric weight estimation methods at a tertiary hospital in Ghana

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: W_E = 3Am / 10 + 5 (for infants <12 months), W_E = 2A + 7 (1 to 4 years) and W_E = 2A + 9 (5 to 13 years), where W_E is estimated weight, A_m 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.

Pediatric weight estimation: validation of the PAWPER XL tape and the PAWPER XL tape mid-arm circumference method in a South African hospital

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.

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.

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

Background Weight estimation during medical emergencies in children is essential, but fraught with errors if the wrong techniques are used, which may result in critical drug dosing errors. Individualised weight estimation is required to allow for accurate dosing in underweight and obese children in particular. This study was designed to evaluate the associations between weight estimations from different systems and body composition in order to establish how and why they may perform well or poorly. Methods A convenience sample of 332 children aged from one month to 16 years had weight estimations using four age-based formulas: the Broselow™ Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL), the Mercy Method, and the Pediatric Advanced Weight Prediction in the Emergency Room, Extra-large/Extra-long Tape (PAWPER XL) Tape. They also had an assessment of body composition using dual x-ray absorptiometry (DXA). The weight estimates were compared against total body weight (TBW), calculated ideal body weight (IBW), and DXA-measured fat-free mass (FFM). Analyses of associations between age, length, weight estimation outcomes, and body composition were performed. Results Age-based formulas were very inaccurate because of the erratic relationship between age and body composition. The Broselow tape estimated IBW well in obese children because of the strong relationship between length and fat-free mass. It predicted TBW poorly in underweight and obese children, however, because of the poor relationship between length and fat mass. The Mercy Method's performance was unrelated to body composition, but estimated TBW reasonably well and could not predict IBW or FFM. The PAWPER XL Tape's performance was the most closely associated with body composition and, therefore, achieved an acceptable accuracy for estimations of TBW, IBW, and FFM. Conclusions Of the systems evaluated, the PAWPER XL Tape has the best association with body composition and the most accurate estimations of TBW, IBW, and FFM.

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.

Global Emergency Medicine: A Review of the Literature from 2018

OBJECTIVES

The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM.

METHODS

An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores.

RESULTS

A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique.

CONCLUSIONS

In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.

The "PAWPER-on-a-page": Increasing global access to a low-cost weight estimation system

BACKGROUND

The PAWPER tape is one of the most accurate weight estimation systems available today, but international access to the tape is limited because it has no commercial distribution. For this reason, the "PAWPER-on-a-page" concept was devised: downloadable image files that allow users to print and assemble their own tapes. However, the feasibility of this method is dependent on users being able to produce accurate tapes. This study was devised to determine whether untrained participants could print and assemble the "PAWPER-on-a-page" easily and accurately.

METHODS

Doctor and nurse volunteers downloaded the "PAWPER-on-a-page" and "PAWPER XL-on-a-page" image files and printed copies on a home-printer and also at a commercial printer. One copy of each tape was then assembled according to instructions from an online video. The accuracy of printing and assembly, the time taken for assembly and the cost were then evaluated.

RESULTS

There were 32 participants. The median time for assembly was 8 minutes 19 seconds and 7 minutes 31 seconds for the "PAWPER-on-a-page" and "PAWPER XL-on-a-page" respectively, with a median cost of USD 0.09 and USD 1.00 respectively. For the assembled tapes, 71.9% of the "PAWPER-on-a-page" tapes and 65.6% of the "PAWPER XL-on-a-page" achieved the required accuracy of 0.2%. Printing errors, related to scaling, were common, but easily detectable.

CONCLUSION

The "PAWPER-on-a-page" system can be easily, quickly, affordably and accurately printed and assembled by end users. Stringent double checking of the printed and fully assembled tapes is essential to ensure accuracy.