Comparison of Two Methods of Pediatric Resuscitation and Critical Care Management

Abstract

We compare time to drug delivery and the incidence of dosage error between 2 different systems of medication administration: The Broselow Pediatric Emergency Tape and a standardized volume/weight-based dose reformulation of resuscitation and critical care medications (reformulated to 0.1 mL/kg). This was a randomized crossover trial, in which volunteers (n=16) from emergency department (ED) pediatric resuscitation teams from the ED of a large, urban, teaching hospital in Australia were assigned to manage simulated (Advanced Pediatric Life Support scenario) patients. The volunteers were each presented with 3 case scenarios (brady-asystolic arrest, status epilepticus, and rapid sequence intubation requiring administration of 4, 5, and 4 medications, respectively). The order of presentation was randomized for the 2 methods. The volunteers were then asked to manage 3 case scenarios using one and then the other method (resulting in a total of 6 cases managed per participant). The dosage of each medication ordered, as well as the time to the simulated administration of that medication, was recorded for all scenarios. The expected dosages were compared with the actual dosages delivered to determine which system provided greater accuracy in medication administration. Statistical analysis was undertaken using the Wilcoxon signed rank test and McNemars test for paired proportions. Compared with the Broselow tape, the standardized volume/weight-based dose reformulation significantly reduced median time to medication delivery for all clinical scenarios (147 versus 72 seconds; 197 versus 87 seconds; 146 versus 64 seconds; P<.001). The proportion of dosing errors with Broselow tape across the 3 scenarios was greater than with volume/weight-based dosing (0.08 versus 0, 0 versus 0, and 0.08 versus 0.02, respectively). Use of a standardized volume/weight-based dose reformulation method is a simple, fast, and accurate method of medication delivery for the pediatric patient that eliminates the need for memorization and/or calculation. The standardized volume/weight-based dose reformulation method performs better than the Broselow tape in speed of delivery of medications used for pediatric resuscitation and critical care without any reduction in dosing accuracy.