Age-based Formula Research Articles

Comparing the performance of pediatric weight estimation methods

BackgroundWeight estimation is essential in the care of ill children when a weight cannot be obtained. This is particularly important for children with medical complexity, who are at higher risk for adverse drug events. Our objective was to compare the accuracy of different methods of weight estimation in children and stratify by the presence of medical complexity. MethodsWe performed a retrospective cross-sectional study of children (<18 years) seen in the emergency department (ED) or ambulatory clinic from January 1, 2013 to December 31, 2022 at a tertiary academic pediatric center. We compared the performance of nine age-based formulae and two length-based methods using metrics of mean average error (MAE), root mean square error (RMSE), and agreement within 10% and 20% of measured weight. We additionally evaluated the approaches stratified by body mass index (BMI) and the presence of medical complexity. ResultsOf 361,755 children (median age 8.2 years, IQR 2.5–14.2 years; 51.5% male), 59,283 (16.4%) were seen in the ED. Length was measured or available in 21,330 (36.0%) patients in the ED and 293,410 (97%) patients in clinics. The Broselow tape outperformed all methods, with 50.7% estimates within 10% of measured weight, 80.0% estimates within 20% of measured weight, the lowest MAE (2.5 kg), and lowest RMSE (4.5 kg). The Antevy formula was the most accurate age-based formula, with 49.2% estimates within 10% of measured weight, 80.1% estimates within 20% of measured weight, MAE of 2.8 kg, and RMSE of 4.7 kg. Estimates became less accurate as BMI and estimated weight increased for all methods. Among children with medical complexity (14.1%), the Broselow tape consistently outperformed age-based formulae, with 47.7% estimates within 10% of measured weight, 77.1% estimates within 20% of measured weight, MAE of 2.6 kg, and RMSE of 5.4 kg. The Antevy formula remained the most accurate age-based method among children with medical complexity. ConclusionThe Broselow tape predicted weight most accurately in this large sample of children, including among those with medical complexity. The Antevy formula is the most accurate age-based method for pediatric weight estimation.

Personalized Lens Correction Improves Quantitative Fundus Autofluorescence Analysis.

Quantitative fundus autofluorescence (QAF) currently deploys an age-based score to correct for lens opacification. However, in elderly people, lens opacification varies strongly between individuals of similar age, and innate lens autofluorescence is not included in the current correction formula. Our goal was to develop and compare an individualized formula. One hundred thirty participants were examined cross-sectionally, and a subset of 30 participants received additional multimodal imaging 2-week post-cataract-surgery. Imaging included the Scheimpflug principle, anterior chamber optical coherence tomography (AC-OCT), lens quantitative autofluorescence (LQAF), and retinal QAF imaging. Among the subset, least absolute shrinkage and selection operator regression and backward selection was implemented to determine which lens score best predicts the QAF value after lens extraction. Subsequently, a spline mixed model was applied to the whole cohort to quantify the influence of LQAF and Scheimpflug on QAF. Age and LQAF measurements were found to be the most relevant variables, whereas AC-OCT measurements and Scheimpflug were eliminated by backward selection. Both an increase in Scheimpflug and LQAF values were associated with a decrease in QAF. The prediction error of the spline model (mean absolute error [MAE] ± standard deviation) of 32.2 ± 23.4 (QAFa.u.) was markedly lower compared to the current age-based formula MAE of 96.1 ± 93.5. Both smooth terms, LQAF (P < 0.01) and Scheimpflug (P < 0.001), were significant for the spline mixed model. LQAF imaging proved to be the most predictive for the impact of the natural lens on QAF imaging. The application of lens scores in the clinic could improve the accuracy of QAF imaging interpretation and might allow including aged patients in future QAF studies.

The development of prediction model for cuffed tracheal tube size from the middle finger in pediatrics: a concise and feasible approach.

Selecting the optimal tracheal tube size is critically important for pediatric patients. Age-based formulas are often used, but still have limitations. The aim of this prospective study was to investigate whether middle finger measurements correlate with cuffed tracheal tube size and to further develop a prediction model based on these measurements. Patients under 12 years of age scheduled for elective surgery involving tracheal intubation were enrolled in the study. The length was determined from the tip of the distal metacarpal to the palm's root on the palm side, while the circumference was measured at the base of the palm using a soft tape measure. The appropriate cuffed tracheal tube size was determined based on specific criteria. If the tube encountered resistance during insertion or required an airway pressure >25 cmH2O to detect an audible leak, it was replaced with a tube 0.5 mm smaller. Conversely, if an audible leak occurred at an airway pressure <10 cmH2O, or peak pressure >25 cmH2O, or the cuff pressure >25 cmH2O to achieve a seal, the tube was exchanged for one with a 0.5 mm larger. Linear regression analysis was used to examine the association between middle finger circumference and length with the cuffed tracheal tube size. Subsequently, regression equations were constructed based on the results of the linear regression analysis and their predictive performance was compared to the conventional age-based formulas, including the Khine formula and Motoyama formula. The predictive performance was evaluated by mean absolute error (MAE), root mean square error (RMSE), and prediction accuracy. A total of 261 patients were analyzed in our study. The mean age of the patients was 46.19±35.83 months. The linear relationship was observed between the cuffed tracheal tube size and the middle finger circumference and middle finger length with R2 values of 0.77 and 0.73, respectively. In comparison to conventional age-based formulas, both middle finger circumference and middle finger length demonstrated superior predictive performance, characterized by lower MAE and RMSE, as well as higher prediction accuracy. Notably, the regression equation based on the middle finger circumference obtained the higher predictive accuracy of 0.590, with an MAE of 0.259 and an RMSE of 0.333 as opposed to the predictive accuracy of 0.391, MAE of 0.349, and RMSE of 0.473 derived from conventional age-based formulas. Based on the regression coefficients of linear regression, simplified formulas were proposed, with the middle finger circumference-based formula emerging as the most accurate and simple option. The appropriate cuffed tracheal tube size could be predicted by the middle finger circumference. Our proposed formula 'cuffed tracheal tube internal diameter (mm) = middle finger circumference (cm) - 0.2' has the potential to improve the selection of the cuffed tracheal tube size in pediatric patients.

The accuracy of the ultrasound measured transverse cricoid diameter and the epiphyseal transverse diameter of the distal radius in predicting the pediatric endotracheal tube size.

In everyday pediatric anesthesia practice, clinicians frequently exchange an already inserted endotracheal tube because of a leak or resistance causing significant morbidity. We investigated the accuracy of two ultrasound measurements; the transverse cricoid diameter and epiphyseal diameter of the distal radius in the prediction of endotracheal tube size that best fits in children compared to age-based formulas. One hundred children (1-6 years) who underwent elective surgery with endotracheal tube whether cuffed (n = 50) or uncuffed (n = 50) were enrolled. The primary endpoint was the agreement between the reference tube size for which its outer diameter was selected based on transverse cricoid diameter and the final best-fit-ETT. The Correlation and Bland Altman agreement tests were conducted between best-fit-ETT outer diameter and ultrasound-measured outer diameter, and between best-fit-ETT inner diameter and inner diameter calculated by age-based formulas. The agreement rate between transverse cricoid diameter-based endotracheal tube size and best-fit-ETT size was 88% in cuffed group compared to 90% in uncuffed group. A significant positive correlation was reported between the outer diameter of best-fit-ETT and the outer diameter measured by the two ultrasound methods. A lower degree of positive correlation was reported between the inner diameter of best-fit-ETT, and the inner diameter calculated by age-based formulas. Bland Altman's analysis showed agreement between best-fit-ETT outer diameter and epiphyseal diameter of the distal radius in both groups and with transverse cricoid diameter in the cuffed group, with no agreement with age-based formulas in either group. Both transverse cricoid diameter and epiphyseal diameter of the distal radius are reliable predictors of the size of best-fit-ETT pediatric endotracheal tube compared to age-based formulas. To save time and effort, we recommend the US measurement of the epiphyseal diameter of distal radius in the preoperative visit and documenting the predicted tube size with the preoperative assessments.

Predicting optimal endotracheal tube size and depth in pediatric patients using demographic data and machine learning techniques.

Use of endotracheal tubes (ETTs) with appropriate size and depth can help minimize intubation-related complications in pediatric patients. Existing age-based formulae for selecting the optimal ETT size present several inaccuracies. We developed a machine learning model that predicts the optimal size and depth of ETTs in pediatric patients using demographic data, enabling clinical applications. Data from 37,057 patients younger than 12 years who underwent general anesthesia with endotracheal intubation were retrospectively analyzed. Gradient boosted regression tree (GBRT) model was developed and compared with traditional age-based formulae. The GBRT model demonstrated the highest macro-averaged F1 scores of 0.502 (95% CI 0.486, 0.568) and 0.669 (95% CI 0.640, 0.694) for predicting the uncuffed and cuffed ETT size (internal diameter [ID]), outperforming the age-based formulae that yielded 0.163 (95% CI 0.140, 0.196, P < 0.001) and 0.392 (95% CI 0.378, 0.406, P < 0.001), respectively. In predicting the ETT depth (distance from tip to lip corner), the GBRT model showed the lowest mean absolute error (MAE) of 0.71 cm (95% CI 0.69, 0.72) and 0.72 cm (95% CI 0.70, 0.74) compared to the age-based formulae that showed an error of 1.18 cm (95% CI 1.16, 1.20, P < 0.001) and 1.34 cm (95% CI 1.31, 1.38, P < 0.001) for uncuffed and cuffed ETT, respectively. The GBRT model using only demographic data accurately predicted the ETT size and depth. If these results are validated, the model may be practical for predicting optimal ETT size and depth for pediatric patients.

A new formula to predict the size and insertion depth of cuffed nasotracheal tube in children receiving dental surgery: a retrospective study

This retrospective study aimed to develop a new formula for selecting the appropriate size and determining the depth of the cuffed nasotracheal intubation (NTI) for a cuffed endotracheal tube (cETT) in pediatric patients undergoing dental surgery. In addition, the clinical data on cETT (i.e., the size and depth of insertion) was compared with those calculated with age-based formulas to evaluate their correlation. A total number of 684 patients who received NTI were enrolled (healthy group, n = 607; special-need group, n = 77). The ETT size used in real-world scenarios was smaller (i.e., about 0.5 and 0.94 mm) than the age-based formula, while the ETT depth was greater (i.e., about 1.5 cm) than the age-based formula in both groups. In the healthy group, age, gender, and body weight were identified as predictors of ETT size and depth through multiple linear regression analysis, while only age and body weight were predictors in the special-needs group. New formulas were developed based on these findings, with ETT size = 3.98 + 0.052 × age + 0.048 × gender (male = 1, female = 0) + 0.023 × body weight (kg) and ETT depth = 15.1 + 0.43 × age + 0.300 × gender (male = 1, female = 0) + 0.007 × body weight (kg). The new formula could be useful for both healthy and special-need pediatric populations undergoing dental procedures.

Correlation between correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in pediatric population

Background: The size of the airway varies greatly in pediatric patients, making it difficult to predict an appropriate size Endotracheal tube (ETT) for securing the airway. Several formulae are used to predict approximate ETT size. With the wider availability of ultrasonography (USG), many clinicians have suggested it as a useful tool for airway management and have used USG to measure tracheal dimensions in adults and children. Aims and Objectives: The primary aim of this study was to evaluate the usefulness of USG for the selection of correct sized uncuffed ETT in pediatric patients and the secondary aim was to correlate the age-based formula with ultrasound measured subglottic diameter for predicting the size of ETT. Materials and Methods: A total of 64 patients of either gender in the age group of 2–6 years were enrolled in the study. Standard anesthetic induction was done and transverse subglottic diameter was measured using USG. The minimal transverse subglottic diameter was measured and noted and the patient was intubated with the tube size as determined by modified Cole’s age-based formula. Results: Out of 64 patients, 33 were male and 31 female. Average age was 3.9 (±1.47) years, 42.2% belonged to the age group of (2–3) years, average weight of the patients was 20.3 (±10.45) kg. The mean ETT outer diameters (OD) based on age-based formula was 6.81 mm compared to 6.91 mm and 6.78 mm by USG based and actual ETT OD, respectively. Both the age based ETT OD and USG-based ETT OD showed good correlation with actual ETT OD used with r-value of 0.891 and 0.876, respectively. Conclusion: Although USG is a non-invasive, cost-effective, and reproducible technique its routine use for estimating ETT size in pediatric patients could not be justified over age-based formula as both of them have comparable results (statistically insignificant). The success rate of age-based formula and USG in precisely predicting ETT outer diameter is comparable with the size of actual ETT outer diameter (78% vs. 75%, P=0.86).

Recommendations for endotracheal tube insertion depths in children

BackgroundEndotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based,...

Comparative study of different formulae for prediction of best fit endotracheal tube size in children

BackgroundVarious formulae have been used to predict appropriate endotracheal tube (ETT) size in children, but there is no consensus regarding the best predictor. Recent use of ultrasonography (USG) to predict the ETT size may not always be feasible leaving the physical parameters as most useful and practical option. The present study was planned to compare age-, height- and weight-based formulae for ETT size prediction in children.ResultsThe accuracy in predicting ETT size was found to be 88.67%, 73.33% and 32.67% for height-based formula (HBF), age-based formula (ABF) and weight-based formula (WBF), respectively. Pearson correlation coefficient was best for HBF (0.968 with 95% CI of 0.937–0.999), followed by ABF (0.942 with 95% CI of 0.887–0.996) and WBF (0.874 with 95% CI of 0.794–0.953). HBF was found to be best suited for children 1–3 years, ≤ 90 cm and weight < 15 kg with accuracy of > 98%, while WBF was unsatisfactory across all age, height and weight groups.ConclusionsHBF is the best predictor of ETT size across all age groups with marginal superiority over ABF, especially in age group < 3 years. WBF was least effective in predicting ideal ETT size. It is recommended that HBF should be preferred over ABF and WBF for selection of ETT size in paediatric patients. This practice assumes greater importance especially in emergency situations where exact age and weight cannot be ascertained while height is easily obtainable.

Comparison of Accuracy of Ultrasound Measurement of Subglottic Diameter Versus Conventional Age Based Formula for Estimating Endotracheal Tube Size for Pediatric Surgical Patients- A Prospective Randomized Controlled Study

Introduction: The main aim of this study is to determine if ultrasonography (USG) based measurement of subglottic diameter is the best size predictor for endotracheal tube (ETT) in pediatric surgical cases over age-based formula with micro cuff tube. Also, to test reintubation percentage and post-operative complications in children. Methodology: This research is double-blind randomized control study with 68 children undergoing elective surgery requiring general anaesthesia with micro cuff tube. They were divided into 2 groups i.e. ETT size by USG (group U) and ETT size by age-based formula group A) (with 34 children in each. Both groups ETT measurement was calculated by independent Samples t-test, and correlation of both groups with actual ET Tube was measured by Pearson’s correlation coefficient. Reintubations or post-op complications was measured by Chi-squared test. Results: Mean age of group A and U are 5.65 ± 2.77 and 5.97 ± 2.77 respectively. Mean weights were from 13.5±2.06 kgs to 27±4.63kgs. Statistical significance with a P-value (P=0.0460) is observed in group U whereas no significance was seen in group A. A strong positive correlation (R=0.960) between USG-estimated ETT size and actual ETT size is observed. The difference in reintubations and post-op complications in group U were statistically significant with P &lt; 0.002. Conclusion: The present study concludes that the sub glottis diameter measured by USG is a good predictor for correct size of micro cuff endo tracheal tube in children.

Validation of three age based weight formulae for estimating weight among Indian children

Background: Weight estimation in paediatric emergencies is often required to calculate drug dosages, fluid therapy and defibrillation. The ‘gold standard’ of actually weighing the patient is not practically possible in emergency conditions. Many formulae have been developed in an attempt to accurately estimate a child’s weight using age like advanced paediatric life support (APLS), Luscombe, and Argall’s modification. However, these formulae might not be applicable in the Indian context. This study aims is to validate standard age-based formulae (APLS, Luscombe, and Argall’s) and their accuracy in estimating the weight of Indian children. Methods: The study used secondary data from the fourth round of the National Family Health Survey (2015-16). The estimated weights as computed by the APLS guidelines, the Luscombe and the Argall formulae were compared to their respective measured weights during the survey. Results: All three formulae (APLS, Luscombe, and Argall) overestimated the weights. The APLS formula exhibited the least weight difference among the different age groups (-3.51±2.08 kg). The average percentage difference between the estimated weights using the APLS, Luscombe, and Argall formula and the actual weights was 23%, 38%, and 28%, respectively. Conclusions: All the three age-based weight formulae, namely APLS, Argyll, and Luscombe, overestimated the weight among the Indian children, clearly showing the need to adjust the formulae for accurate weight estimation of Indian children.

An anthropometric evidence against the use of age-based estimation of bodyweight in pediatric patients admitted to intensive care units

Age-based bodyweight estimation is commonly used in pediatric settings, but pediatric ICU patients often have preexisting comorbidity and resulting failure to thrive, hence their anthropometric measures may be small-for-age. Accordingly, age-based methods could overestimate bodyweight in such settings, resulting in iatrogenic complications. We performed a retrospective cohort study using pediatric data (aged < 16 years) registered in the Japanese Intensive Care Patient Database from April 2015 to March 2020. All the anthropometric data were overlaid on the growth charts. The estimation accuracy of 4 age-based and 2 height-based bodyweight estimations was evaluated by the Bland–Altman plot analysis and the proportion of estimates within 10% of the measured weight (ρ10%). We analyzed 6616 records. The distributions of both bodyweight and height were drifted to the lower values throughout the childhood while the distribution of BMI was similar to the general healthy children. The accuracy in bodyweight estimation with age-based formulae was inferior to that with height-based methods. These data demonstrated that the pediatric patients in the Japanese ICU were proportionally small-for-age, suggesting a special risk of using the conventional age-based estimation but supporting the use of height-based estimation of the bodyweight in the pediatric ICU.

A new formula based on height for determining endotracheal intubation depth in pediatrics: A prospective study

Study objectiveThe main objective was to devise an endotracheal intubation formula based on pediatric patients' strongly correlated growth parameters. The secondary objective was to compare the accuracy of the new formula to the age-based formula from Advanced Pediatric Life Support Course (APLS formula) and the middle finger length-based formula (MFL-based formula). DesignA prospective, observational study. SettingOperation. Patients111 subjects age 4–12 years old undergoing elective surgeries with general orotracheal anesthesia. Interventions and measurementsGrowth parameters, including age, gender, height, weight, BMI, middle finger length, nasal-tragus length, and sternum length, were measured before surgeries. Tracheal length and the optimal endotracheal intubation depth (D) were measured and calculated by Disposcope. Regression analysis were used to establish a new formula for predicting the intubation depth. A self-controlled paired design was used to compare the accuracy of the intubation depth between the new formula, APLS formula, and MFL-based formula. Main resultsHeight (R = 0.897, P < 0.001) was strongly correlated to tracheal length and the endotracheal intubation depth in pediatric patients. New formulae basing on height were established, including new formula 1: D (cm) = 4 + 0.1 × Height (cm) and new formula 2: D (cm) = 3 + 0.1 × Height (cm). Via Bland-Altman analysis, the mean differences for new formula 1, new formula 2, APLS formula and MFL-based formula were − 0.354 cm (95% LOA, −1.289 to 1.998 cm), 1.354 cm (95% LOA, −0.289 to 2.998 cm), 1.154 cm (95% LOA, −1.002 to 3.311 cm), −0.619 cm (95% LOA, −2.960 to 1.723 cm), respectively. The rate of optimal intubation for new formula 1 (84.69%) was higher than for new formula 2 (55.86%), APLS formula (61.26%), and MFL-based formula. (69.37%). ConclusionsThe prediction accuracy for intubation depth of the new formula 1 was higher than the other formulae. The new formula based on height: D (cm) = 4 + 0.1 × Height (cm) was preferable to APLS formula and MFL-based formula with a high incidence of appropriate endotracheal tube position.

Choice of the correct size of endotracheal tube in pediatric patients.

Selection and insertion of an endotracheal tube (ETT) of appropriate size for airway management during general anesthesia in pediatric patients is very important. A very small ETT increases the risk of inadequate ventilation, air leakage, and aspiration, whereas a very large ETT may cause serious complications including airway damage, post-intubation croup, and, in severe cases, subglottic stenosis. Although the pediatric larynx is conical, the narrowest part, the rima glottidis, is cylindrical in the anteroposterior dimension, regardless of development, and the cricoid ring is slightly elliptical. A cuffed ETT reduces the number of endotracheal intubation attempts, and if cuff pressure can be maintained within a safe range, the risk of airway damage may not be greater than that of an ETT without cuff. The age-based formula suggested by Cole (age/4 + 4) has long been used to select the appropriate ETT size in children. Because age-based formulas in children are not always accurate, various alternative methods for estimating the ETT size have been examined and suggested. Chest radiography, ultrasound, and a three-dimensional airway model can be used to determine the appropriate ETT size; however, there are several limitations.

The PAWPER tape as a tool for rapid weight assessment in a Paediatric Emergency Department: Validation study and comparison with parents’ estimation and Broselow tape

AimTo validate the PAWPER tape and assess its inter-observer reliability in children accessing a Paediatric Emergency Department (PED). As secondary outcome we compared the accuracy of the PAWPER tape with that of parents’ estimation, the Broselow tape and the European Paediatric Life Support (EPLS) formula. MethodsThis was a cross-sectional study of children (0–12 years) enrolled in a tertiary Paediatric Emergency Department in Italy. Children’s weight was estimated by parents and by trained healthcare providers using the PAWPER tape, the Broselow tape and the EPLS formula. The root mean squared percentage error (RMSPE) for the estimation of precision was calculated. Overall accuracy was evaluated using the percentage of weight estimation falling within 10% (PW10) and 20% (PW20) of real weight. ResultsThe study included 2060 children. Parental estimation was the most accurate and precise method. The PAWPER tape was accurate throughout all habitus sizes except for extreme underweight and overweight categories. Furthermore, it was more accurate and more precise than the Broselow tape and the EPLS formula (p adjusted <0.001). ConclusionsThe PAWPER tape served as an accurate method for weight estimation in children accessing a Paediatric Emergency Department, with excellent inter-rater reliability. It performed significantly better than other length or age-based tools, showing good accuracy and precision except for very extreme weights. Whilst parents’ estimation yielded to be the most accurate and precise method, the age-based EPLS formula was not reliable for estimating weight in all subcategories of habitus.

ULTRA-SONOGRAPHIC ESTIMATION OF ENDOTRACHEAL TUBE SIZE IN PAEDIATRIC PATIENTS UNDERGOING SURGERY IN PRONE POSITION: A PROSPECTIVE OBSERVATIONAL CLINICAL STUDY

Background: ETT is important in securing paediatric airway and its right size plays crucial role in paediatric patients. The airway anatomy in paediatric patients is different from adults hence requires precise ETT size. The subglottic diameter being the narrowest portion of upper airway, determines the ETT size. USG is safe, reliable, non-invasive tool used to estimate the narrowest subglottic diameter to estimate the correct ETT size. Conventional formulae included age and height. Concerns in prone position include accidental extubation,secretions, difficult airway access, increased abdominal pressure, increased FRC. Methods: Sixty patients in the age group 1-4 years posted for PSARP under GA were included in the study. USG guided ETT size was estimated and compared with conventionally estimated size. Results:The size of ETT predicted by USG was more appropriate than that estimated by physical indices(p&lt;0.005). ETT size estimated by age-based formula was 2nd nearest to best fit tube. 65% patients were intubated in 1st attempt while 31.6% required 2nd attempt and 3.33% needed 3 attempts to get intubated with the best fit ETT. Conclusion:USG is useful and reliable screening modality in estimating appropriate ETT size especially in paediatric patients undergoing surgery even in prone position such as PSARP.

Accuracy Comparison between Four Methods of Endotracheal Tube Diameter Estimation for Pediatric Patients

Abstract Background: Successful intubation with the correct endotracheal tube (ETT) size is more difficult to achieve in pediatric patients. Several estimation methods exist, including ultrasonography and several conventional methods, but it is unclear which would be the most accurate method. Thus, this study aimed to compare the accuracy between several ETT diameter estimation methods. Materials and Methods: This was an observational study with a cross-sectional design. The sample includes pediatric patients (0–6 years) at a tertiary hospital recruited from January 2022 to March 2022. Primary data evaluated included age, gender, height, weight, actual ETT size used in the procedure, and the estimation of ETT size obtained by four different methods: ultrasonography, little finger diameter, little fingernail width, and age-based formula. Primary analysis was linear regression test between estimated diameter and the actual ETT diameter used in the procedure, controlling for potential confounders. The accuracy of each ETT size estimation method was seen from the values of the B and R2 coefficients from the linear regression test results. Results: Ultrasonography was found as the most accurate method, with B and R2 coefficients of 0.963 and 0.991, respectively. Among conventional methods, the diameter of the little finger was the most accurate (B = 0.918, R2 = 0.772). The age-based formula method was found to be the least accurate (B = 0.797, R2 = 0.735). Conclusion: Linear regression tests confirmed that the ultrasonography was the estimation method with the highest accuracy. For healthcare facilities with limited resources, the estimation method with little finger diameter should be considered.

Airway ultrasound predicts endotracheal tube size more accurately than Cole’s age-based formula in paediatric patients

Airway ultrasound predicts endotracheal tube size more accurately than Cole’s age-based formula in paediatric patients

A Comparison of Actual versus Estimated Weights among Filipino Children Using the Original and Updated Advanced Paediatric Life Support (APLS) Formulae, Mercy Method and Broselow Tape: A Prospective Study

Introduction. In resuscitating children, actual weight should be obtained before intervention. However, this is not always possible in the emergency setting. Identifying a simple, accurate, and precise method of weight estimation is essential in the delivery of optimal care for Filipino children seen at the emergency department.&#x0D; Objectives. To evaluate and compare the accuracy and precision of different weight estimation methods in Filipino children.&#x0D; Methods. A cross-sectional, single-center study was conducted among patients aged &gt;28 days-12 years seen at the Philippine General Hospital Emergency Room. The traditional and updated Advanced Pediatric Life Support (APLS), Broselow tape, and Mercy Method were used for weight estimation. Bland Altman analysis was performed to see the mean difference and limits of agreement between actual and estimated weights of the children.&#x0D; Results. Broselow tape gave the closest average weight estimate, overestimating it by 0.7 kg, followed by Mercy method at 0.955 kg higher than actual. Traditional APLS yielded 1.565 kg and the Updated APLS 3.299 kg. Mercy Method had the narrowest limit of agreement.&#x0D; Conclusion. Among the four weight estimation methods, Broselow tape is the most accurate while the Mercy method is the most precise. Traditional APLS performed better than the updated APLS. Length-based methods and anthropometric surrogates proved to be more reliable than age-based formulae.

Comparison of Ultrasonography with Cole’s Formula to Determine Appropriate Endotracheal Tube Size in Pediatric Population

Introduction: Recently, ultrasonography (USG) has gained popularity in perioperative airway management . One of the commonest method to select endotracheal tube in pediatric patients is Cole’s formula. Our study was conducted to assess if there was a measurable difference in the appropriateness of the endotracheal tubes as selected by the two methods. Methods: The study group included 68 children scheduled for elective surgeries under general anesthesia with endotracheal intubation in an randomized prospective manner. The size of endotracheal tube was calculated using Cole’s formula in group A. In group B, ultrasound was done to measure the subglottic transverse diameter at the level of cricoid to find the largest outer diameter of tube . Results: Ultrasonography group measuring the subglottic diameter was found to have more appropriately sized tubes than age-based Cole's formula (76.5% Vs 58.8% p=0.007). The pressure equilibrated measured (13.2 ± 5.2 cm of H2O in age based group and 17 ± 4.5 cm of H2O in ultrasonography group) was statistically significant (p=0.002). Also the incidence of selecting an inappropriately small sized ET tube was lower in the ultrasound group (5.9% Vs 35.3%). There were no significant differences in the number of intubation attempts and mean time required for intubation between the two groups. Conclusion: Ultrasonographic method is a suitable alternative tool in predicting the size of uncuffed endotracheal tube in pediatric population than age-based Cole’s formula.