Abstract
BackgroundWeight 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.MethodsA 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.ResultsAge-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.ConclusionsOf the systems evaluated, the PAWPER XL Tape has the best association with body composition and the most accurate estimations of TBW, IBW, and FFM.
Highlights
The ultimate purpose of the weight estimation systems used during the management of medical emergencies in children is to enable the administration of accurate doses of potentially life-saving drugs [1]
The PAWPER XL Tape’s performance was the most closely associated with body composition and, achieved an acceptable accuracy for estimations of total body weight (TBW), ideal body weight (IBW), and fat-free mass (FFM)
The PAWPER XL Tape has the best association with body composition and the most accurate estimations of TBW, IBW, and FFM
Summary
The ultimate purpose of the weight estimation systems used during the management of medical emergencies in children is to enable the administration of accurate doses of potentially life-saving drugs [1]. An understanding of how and why these systems can fail would provide insight into which methodologies should be preferred and how they should be used within the context of the overall medical management of the critically ill or injured child. It would provide understanding into how they could be improved. 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
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