Advanced Paediatric Life Support Formula Research Articles

To Determine the Accuracy and Reliability of Broselow Tape in Comparison with Actual Weight and Advance Pediatric Life Support Formula Weight Assessment among the Pediatric Population Presenting to Emergency Department of a Low Income Setting

Background: Near precise weight assessment among sick pediatric patients remains a dilemma and conventionally accepted weight assessment methods, in busy ED might be inaccurate or unreliable. Children have different weights at different ages, and accurate/precise weight measurement is of utmost importance for weight-related dose calculation of drugs/fluids, equipment sizes, an accurate dose of electrical currents during cardiac shock, etc. Several weight estimation methods are available and are dependent on the child's age, length, or both. However, length or length-and-age-based methods may have greater accuracy than merely age-based, still precise weight measurement while children are recumbent (length) has its own challenges. Objective: We determined the accuracy and reliability of BT by comparing it with actual weight and advanced pediatric life support formula (APLS) among the pediatric population presenting to the emergency department. Methods: This was a single-center, cross-sectional study design. This study was conducted at pediatric emergency of an urban tertiary care hospital after ethics committee approval and written consent from parents/caregivers during July 2021- June 22. Pediatric patients aged 1 month to 12 years, weight 3-36 kg, and height 46.5-142.5 cm on BT were included. Actual weight was measured on a standard weighing machine. We use Broselow pediatric emergency tape (2017 edition), APLS formula was also used to measure the estimated weight by using the age provided by parents. Descriptive analysis, mean and standard deviation were calculated, frequencies and percentages were calculated for categorical variables. Cronbach’s alpha and Passing-Bablok regression analysis was applied to assess the reliability and identify systematic biases between actual body weights with estimated BT. Bland–Altman analysis was also performed to measure the precision, accuracy, and bias. Results: 250 children were included with equal gender distribution and were divided in to three categories as per the weight estimation by BT in to <10 kg (n=58, 23.2%), 10-18 kg (n=151, 60.4%) and >18 kg (n=41, 16.4%). The mean age was 5.26 (±2.37) years, majority of children were below 5 years of age (n=144, 58%). Positive agreement between BT weight with actual weight and other formulas in weight category of <10 kg, however as weight increases from 10 kg, onward results are not significant. Passing and Bablok Regression analysis showed a positive correlation between the estimated and actual (AW) body weight (r=0.9280, p<0.001) and accuracy (r2=0.929), and the accuracy of BT weight decreases with the increasing weight of children. Similarly, 95% agreement limit and mean biased was 0.465 to 1.113 and 0.789±2.602 between BT and APLS, BT with AW was -0.50 to -0.28 and -0.39±0.885. Comparing and correlating weight assessment of APLS formula vs LF and TF didn't show significance with a p-value of 0.041 and 0.034 respectively. Bland-Altman plot between BT measurement with AW demonstrates a bias equal to 1.096 kg with a limit of 0.870 to 1.815. Conclusion: BT may be an accurate and time bound method of weight measurement as compared to other methods of weight estimation, however the accuracy of BT may be adversely affected with age exceeding 95 months and weight >26 kg. BT may be safely used in the younger pediatric population. Health care professionals may consider this information while using BT to estimate weight for pediatric resuscitation, however, this is a single center hospital based study with limited cases, we recommend to have a large scale community based study or a census before to generalize these results to general population.

A systems-centred approach to reducing medication error: Should pre-hospital providers and emergency departments dose children by age during resuscitation?

The high-risk, high-stress and high-stakes environment of out-of-hospital or emergency department paediatric resuscitation is prone to human error, and medication errors are common. This could be contributing to the difference in survival rate of resuscitation in the out-of-hospital versus inpatient setting. Medication for children during resuscitation requires estimation of the child's weight and calculation of the corresponding drug dose. Whilst both of these steps can lead to error, calculation errors (including 10-fold errors) are much more common and harmful than weight errors. Previous solutions aim to optimise each stage of the medication dosing process. Currently, Australian guidelines suggest using the highly inaccurate original advanced paediatric life support formula, weight = 2 × (age + 4), to dose medications in these settings. This means age is converted to weight, which is then converted to dose. There is no evidence that this is causing harm to patients. Therefore, it could be suggested that age could safely be converted straight to dose according to preset doses. This eliminates the need for any weight estimation or dose calculation, thus reducing the potential for error and harm.

Estimating children's weight in a Rwandan emergency centre.

IntroductionMost drugs, fluids and ventilator settings depend on the weight of a paediatric patient. However, knowledge of the weight is often unavailable as the urgency of the situation may impede measurement. The most common methods for paediatric weight estimation are based on height or age. This study aimed to compare the accuracy of various weight estimation methods and to derive a dedicated age-based tool within a Rwandan setting.MethodsThis was a retrospective study using age, weight and height data from randomly selected charts of Rwandan children, aged between one and ten years, who attended the paediatric emergency centre, Centre Hospitalier Universitaire de Kigali, Rwanda. Weights were estimated using four versions of the Broselow Tape and several age-based formulae. Linear regression was used to derive a new age-based weight estimation formula, the Rwanda Rule. Weight estimations were then compared with actual weight using Bland-Altman analysis, and the proportions of estimates within 10 and 20% of actual weight.ResultsThere were 327 children included in the study. The derived Rwanda Rule was: weight (kg) = [1.7 × age (years)] + 8. This formula and the original Advanced Paediatric Life Support formula (weight = [2 × age] + 8) performed similarly. Both were better than other age-based formulae (69% of estimates within 20% of actual weight). All editions of the Broselow Tape performed better than age-based rules. The 1998 version performed best with 84.8% of estimates within 20% of actual weight.DiscussionThis study is the first to compare paediatric weight estimation methods in Rwanda. Locally, and until we have evidence from further research that other methods are superior, we would advise use of the 1998 Broselow Tape in children aged one to ten years old. Where the Broselow Tape is not available, the original Advanced Paediatric Life Support formula should be used.

Comparison of Actual and Estimated Body Weight Using Mid Upper Arm Circumference, Broselow Tape and Advanced Pediatric Life Support (APLS) Formula Among Children Age 1 to 12 Years Old

Background: Medications and fluids used among pediatric patients are computed based on weight. The Broselow tape and the Advanced Pediatric Life Support (APLS) formula are currently being used to predict the actual weight, however, studies have shown that when used on patients of different ethnicity and varying body mass index (BMI), it over/underestimates the weight. Studies done among Chinese and Indian children as well as elderly patients made use of a formula using Mid Upper Arm Circumference (MUAC): (MUAC-10) × 3 to predict weight. As of this time, there is no published literature on methods for approximating weight among Filipino children. Objectives: This study aims to determine which of the methods can be used among Filipino children aged 1 to12 years old to predict the weight. Methodology: Patients seen at University of Santo Tomas Outpatient Department were weighed using a mechanical beam scale, length determined using Broselow Tape and the MUAC using a standard tape measure and recorded. Results: Three hundred sixty participants were included and grouped according to sex, age and BMI. The results showed that the three methods had a positive correlation and were comparable to the actual weight. Of the three methods tested, MUAC had the strongest independent relationship, and seen to be more accurate and precise compared to Broselow and APLS formula. Conclusions: Any of previously mentioned methods may be used among Filipino children age 1 to 12 years old, with the MUAC formula being the most accurate and precise in estimating weight. Another advantage of using the MUAC formula is its reproducibility, since the material used for measurement is readily available and that it is easy to do.

Evaluation of the accuracy of common weight estimation formulae in a Zambian paediatric surgical population.

Limited resources and access to healthcare in sub-Saharan Africa are associated with high rates of malnourished children, although many countries globally are demonstrating increasing childhood obesity. This study evaluated how well current age- or height-based formulae estimate the weight of children undergoing surgery in Zambia. All children under 14 years of age presenting for elective surgery at the University Teaching Hospital, Lusaka, had both height and weight measured. Their actual weight was compared against estimated weight from various formulae. The Broselow tape outperformed all the age-based formulae, demonstrating the lowest median percentage error of -5.8%, with 46.0% of estimates falling within 10% of the actual measured weight (p < 0.001). Of the 1111 children who were eligible for World Health Organization growth standard appraisal, 88 (8%) met the weight criteria for severe acute malnutrition. Our results are consistent with other studies in finding that the Broselow tape is the best estimator of weight in a lower middle-income country, followed by the original Advanced Paediatric Life Support formula if the Broselow tape is unavailable.

Validity of Mothers' Reports of Children's Weight in Japan.

Estimation methods for pediatric weight have not been evaluated for Japanese children. This study aimed to assess the accuracy of mothers' reports of their children's weight in Japan. We also evaluated potential alternatives to the estimation of weight, including the Broselow tape (BT), Advanced Pediatric Life Support (APLS), and Park's formulae. We prospectively collected cross-sectional data on a convenience sample of 237 children aged less than 10 years who presented to a general pediatric outpatient clinic with their mothers. Each weight estimation method was evaluated using Bland- Altman plots and by calculating the proportion within 10% and 20% of the measured weight. Mothers' reports of weight were the most accurate method, with 94.9% within 10% of the measured weight, the lowest mean difference (0.27kg), and the shortest 95% limit of agreement (－1.4 to 1.9kg). The BT was the most reliable alternative, followed by APLS and Park's formulae. Mothers' reports of their children 's weight are more accurate than other weight estimation methods. When no report of a child's weight by the mother is available, BT is the best alternative. When an aged-based formula is the only option, the APLS formula is preferred.

Is the Broselow Tape and APLS formula applicable to Nigerian children? The Kano experience

Background: Weight estimation is useful in pediatric practice; it is used in drug dosage calculation and for nutritional assessment. However, in comatose children actual weight measurement may not be possible therefore weight estimation becomes imperative. The Advanced Pediatric Life Support (APLS) formula and the Broselow Tape have been validated in most developed countries, but not in Nigerian children. Objective: To determine the performance of APLS formula and Broselow Tape in Nigerian children. Materials and Methods: The actual weight of 300 children in the Pediatric Emergency Unit and the Outpatient Department of Aminu Kano Teaching Hospital were taken using weighing scales and their length was also taken; these were compared with values estimated from their ages using the APLS formula and the Broselow Tape. Results: Both methods had similar pattern of performance, underestimating weight (39.7%) in the 1-year age group, and overestimation in the older age groups; however, these were within 95% limit of agreement. The overall average percentage difference was 5.3% and 5.4% for the Broselow Tape and APLS formula, respectively. The proportion of agreement within 10% of the actual weight were 36.8%, 48.8%, 64.3%, 48.1%, and 54.1% for 1, 2, 3, 4, and 5-year age groups, respectively. Conclusion: Both methods are of benefit in Nigerian children, although they underestimated weight in children within the 1-year-age-group.

Finger counting: an alternative method for estimating pediatric weights

ObjectivesWe compared the accuracy of a conceptually simple pediatric weight estimation technique, the finger counting method, with other commonly used methods. MethodsWe prospectively collected cross-sectional data on a convenience sample of 207 children aged 1 to 9 presenting to our pediatric emergency department. Bland-Altman plots were constructed to compare the finger counting method to the Broselow tape method, parental estimate, the Luscombe formula, and the advanced pediatric life support (APLS) formula. Proportions within 10% and 20% of measured weight were compared. ResultsMean difference and range of agreement in kilograms for Bland-Altman plots were as follows: −1.8 (95% confidence interval [CI], −2.3 to −1.3) and 15.4 (95% CI, 13.6-17.2) for the finger counting method; −1.4 (95% CI, −2.0 to −0.9) and 15.8 (95% CI, 13.9-17.6) for the Broselow method; −0.02 (95% CI, −0.53 to 0.49) and 14.8 (95% CI, 13-16.6) for parental estimate; 0.2 (95% CI, −0.33 to 0.72) and 15.3 (95% CI, 13.5-17.2) for the Luscombe formula; and −3.8 (95% CI, −4.4 to −3.2) and 17.2 (95% CI, 15.2-19.2) for the APLS formula. The finger counting method estimated weights within 10% in 59% of children (95% CI, 52%-65%) and within 20% in 87% of children (95% CI, 81%-91%). Proportions within 10% were similar for all methods, except the APLS method, which was lower. ConclusionsThe finger counting method is an acceptable alternative to the Broselow method for weight estimation in children aged 1 to 9 years. It outperforms the traditional APLS method but underestimates weights compared with parental estimate and the Luscombe formula.

G143(P) Is There a Case to Emphasise the Use of Luscombe Formula Instead of the Advanced Paediatric Life Support Course Formula For the Paediatric Weight Calculation?

AimTo validate Luscombe’s formula (LF) for paediatric weight calculation comparing with the measured weight and the calculated weight by the Advanced Paediatric Life Support (APLS) formula and applying it to...

Make your Best Guess: An updated method for paediatric weight estimation in emergencies

For children requiring weight-based resuscitative measures, it is often difficult to obtain an accurate weight. In these cases, it is common practice to estimate the weight based on age. As the average weight of Australian children has increased over the last two decades, the widely used advanced paediatric life support (APLS) method might systematically underestimate weight in paediatric patients. To devise a simple age-based method for estimating weight that is more accurate than the APLS method. A retrospective observational study of all patients (aged 0-14 years) presenting to a tertiary paediatric ED over a 3 year period was performed. Presentations were divided into infants (<12 months), preschool-aged (1-4 years) and school-aged children (5-14 years). Weight measurements performed at triage were recorded and regression analysis performed to produce equations describing the relationship between weight and age for each group. There were 70,181 presentations suitable for inclusion in the present study. Mean weight for age (+/-2 SD) is presented in tabular form. Three simplified linear equations were derived to calculate mean weight for age. For Infants < 12 months: Weight (kg) = (age in months + 9)/2 For Children aged 1-5 years: Weight (kg) = 2 x (age in years + 5) For Children aged 5-14 years: Weight (kg) = 4 x age in years. The present study devised an age-based method for paediatric weight estimation which should more accurately predict weight than the widely used APLS formula.