Age-based Formula Research Articles

How Much Lumbar Lordosis does a Patient Need to Reach their Age-Adjusted Alignment Target? A Formulated Approach Predicting Successful Surgical Outcomes.

Retrospective cohort study. Identify optimal lumbar lordosis in adult deformity correction to achieve age-adjusted targets and sustained alignment. Surgical adult spinal deformity patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regression analysis was used to identify the relationship between regional curvatures (LL and TK) that enabled achievement of a given global alignment (T1 pelvic angle, TPA) based on pelvic incidence (PI). 347 patients out of 1048 available reached their age-adjusted TPA within 5° (60-year-old, 72% women, body mass index 29 ± 6.2). They had a significant improvement in all sagittal parameters (except PI) from pre-operative baseline to 1year following surgery (P < .001). Multilinear regression predicting L1-S1 based on TK, TPA, and PI demonstrated excellent results (R2 = .85). Simplification of the coefficients of prediction combined with a conversion to an age-based formula led to the following: LL = PI - 0.3TK - 0.5Age + 10. Internal validation of the formula led to a mean error of -.4°, and an absolute error of 5.0°. Internal validation on patients with an age-adjusted alignment revealed similar accuracy across the entire age-adjusted TPA spectrum (ranges of LL errors: ME = .2° to 1.7°, AE = 4.0° to 5.3°). This study provides a simple guideline to identify the amount of LL needed to reach a given alignment (i.e., age-adjusted target) based on PI and associated TK. Implementation of this predictive formula during pre-operative surgical planning may help to reduce unexpected sub-optimal post-operative alignment outcomes.

Prediction of endotracheal tube size in the pediatric age group by ultrasound: A systematic review and meta-analysis.

Anatomical differences in the airway in pediatric patients, compared to adults pose many challenges during endotracheal intubation, such as selecting the proper sized endotracheal tube (ETT) during intubation. Our primary objective was to assess how accurate is ultrasound (US) co-relation in comparison to standard age-based formulas in pediatric patients. Meta-analysis was registered in PROSPERO 2020, CRD42020220041. Online literature available in PubMed, Cochrane, and Embase, Goggle scholar was searched from year 2000 till November 30, 2020, using relevant Mesh terms, ('airway US' OR (('airway'/exp OR airway) AND ('US'/exp OR US))) AND ('endotracheal intubation'/exp OR 'endotracheal intubation') AND ('pediatric'/exp OR pediatric)" to Predict endotracheal tube size/placement in pediatric age (neonate till 18 years) by the US. Bibliographic cross-references of selected publications were further manually screened. The full texts of each article were studied, once the abstract was found appropriate independently by two reviewers. A total of 48 papers published between 2010 and 2020 were identified as relevant and read in detail. Average numbers of patients were 86 and total numbers of patients were 1978. Most of the studies included pediatric patients posted for elective surgeries under general anesthesia and excluded emergency procedures, known laryngeal or tracheal pathology, high-risk patients, recent upper respiratory tract infections or allergy to ultrasound gel. A total of 18 independent correlations were analyzed. Final combined r value calculated from all the included articles was 0.824 (95% CI 0.677, 0.908) with a P < 0.00001 {strong co-relation (r > 0.80)}. Q statistic of 756.484, and I2 statistics of 97.53% showed a large degree of heterogeneity in the effect size across the studies. Use of US for upper airway in pediatric patients is an effective modality and can effectively predict endotracheal tube size estimations in comparison to standard age-based or height-based formulae in the pediatric age group. US is a non-invasive, cost-effective, portable, and reproducible technique as compared to CT and MRI. It also takes less time with increasing expertise and experience.

The Effect of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services

Objectives: Up to 40% of children who receive a medication from emergency medical services (EMS) are subject to a dosing error. One of the reasons for this is difficulties adjusting dosages for weight. Converting weights from pounds to kilograms complicates this further. This is the rationale for the National EMS Quality Alliance measure Pediatrics-03b, which measures the proportion of children with a weight documented in kilograms. However, there is little evidence that this practice is associated with lower rates of dosing errors. Therefore, our objective was to determine whether EMS documentation of weight in kilograms was associated with a lower rate of pediatric medication dosing errors. Methods: We conducted a retrospective cross-sectional study of children 0-14 y/o in the 2016-17 electronic Maryland Emergency Medical Services Data System that received a weight-based medication. Using validated age-based formulas, we assigned a weight to patients without one documented. Doses were classified as errors and severe errors if they deviated from the state protocol by >20% or >50%, respectively. We compared the dosage errors in the two groups and completed secondary analyses for specific medications and age groups. Results: We identified 3,618 cases of medication administration, 53% of which had a documented weight. Patients with a documented weight had a significantly lower overall dose error rate than those without (22 vs. 26%, p<.05). A sensitivity analysis in which we assigned a weight to those patients with a weight recorded did not significantly change this result. Sub-analyses by individual medication showed that only epinephrine (34 vs. 56%, p<.05) and fentanyl (10 vs. 31%, p <.05) had significantly lower dosing error rates for patients with a documented weight. Infants were the only age group where documenting a weight was associated with a lower dosing error rate (33 vs. 53% p<.05). Conclusion: Our findings suggest that documenting a weight in kilograms is associated with a small but significantly lower rate of pediatric dosing errors by EMS. Documenting a weight in kilograms appears particularly important for specific medications and patient age groups. Additional strategies (including age-based standardized dosing) may be needed to further reduce pediatric dosing errors by EMS.

Prediction of endotracheal tube size for pediatric patients from the length of the middle finger in comparison with standard age-based formula in South Indian population

Prediction of endotracheal tube size for pediatric patients from the length of the middle finger in comparison with standard age-based formula in South Indian population

Length of the middle finger of hand as a simple and reliable predictor of optimal size of uncuffed endotracheal tube in paediatric patients: An observational study.

Background and Aims:A recent study suggested middle finger length-based formula as a better predictive guide compared with age-based formula for selecting uncuffed endotracheal tubes (ETTs) in children. But that study did not meet sample size requirement. Thus, we primarily aimed to determine the accuracy of formula using length of the middle finger to determine the internal diameter of the uncuffed ETT and to compare its accuracy with the Cole's formula. As a secondary objective, we desired to compare its accuracy with some commonly used length and weight-based formulae.Methods:This prospective observational study included children aged up to 12 years posted for elective surgery under general anaesthesia. The length of the middle finger on the palmar aspect of the hand was measured in the preoperative period and the characteristics of the airway used were noted. A predefined criterion of optimal size of the uncuffed ETT was used.Results:A total of 139 patients were included in the final analysis. It was observed that the formula based on middle finger length can predict the optimal size of uncuffed ETT within an error of 0.5 mm in more than 90% instances and its predictive performance is better than Cole's formula. As a secondary outcome, we also observed that its accuracy is better than other formulae under evaluation.Conclusion:Formula based on middle finger length can be used as a predictor of optimal size of uncuffed ETT in paediatric patients and it is a better predictor than Cole's formula.

281 The Impact of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services

Up to 40% of children who receive a medication from emergency medical services (EMS) are subject to a dosing error. The reasons for this are multifactorial but include difficulties adjusting drug dosages for patient weight. The conversion of patient weight from pounds to kilograms compounds this latent safety threat. In 2014 the National Highway Traffic Safety Administration launched the EMS Compass Project. One of three pediatric performance improvement measures was the proportion of children who received a weight-based medicine from EMS who had a weight documented in kilograms. This was also included in the initial National EMS Quality Alliance (NEMSQA) Measure Set. Despite inclusion in these benchmarks, there is little direct evidence that EMS documentation of a weight in kilograms is associated with lower rates of pediatric medication dosing errors. Our primary objective was to determine whether EMS documentation of a weight in kilograms was associated with a lower rate of pediatric medication dosing errors. We conducted a cross-sectional study using the 2016-17 Maryland state EMS database. We included all patients aged 0-14 years old who received a weight-based medication. Using validated age-based formulas, we assigned a weight (+/- 20% sensitivity margin) to patients who did not have one documented. Medication doses were classified as errors and severe errors if they deviated from the state protocol dose by > 20% or > 50% respectively. We used chi-squared tests to compare the proportion of medication dosage errors for children with and without a documented weight. We completed sub-analyses for the most commonly administered medications and by patient age group. We identified 3,618 eligible cases of medication administration. 1,927 (53%) of these records had a documented weight (Figure 1). Patients with a documented weight had a significantly lower overall rate of medication dosing errors when compared to those without (22 vs. 26%, p < .05) (Table 1). A sensitivity analysis where we assigned a weight to those patients with a weight recorded did not significantly change this result. Only epinephrine (34 vs. 56%, p < .05) and fentanyl (10 vs. 31%, p < .05) had significantly lower rates of medication dosing errors for patients with a documented weight. Infants had the highest rate of medication dosing errors. They were the only age group where documenting a weight was associated with a significantly lower dosing error rate (33% vs. 53%. P < .05) (Table 2). A limitation of our study is that we only had access to a limited dataset and could not analyze for confounding variables associated with dosing errors. Our overall rates of pediatric dosing error by EMS are lower than previously reported. Our findings suggest that documenting a weight in kilograms is associated with a small but significantly lower pediatric medication dosing errors rate. Our results show that documenting a weight in kilograms is particularly important for specific medications and patient age groups. Additional strategies (including age-based standardized dosing) may be needed to further reduce pediatric medication dosing errors by EMS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparing the Impact of Heart Rate-Based In-Game Adaptations in an Exergame-Based Functional High-Intensity Interval Training on Training Intensity and Experience in Healthy Young Adults.

Physical inactivity remains one of the biggest societal challenges of the 21st century. The gaming industry and the fitness sector have responded to this alarming fact with game-based or gamified training scenarios and thus established the promising trend of exergaming. Exergames—games played with the (whole) body as physical input—have been extolled as potential attractive and effective training tools. Simultaneously, researchers and designers are still exploring new approaches to exploit the full potential of this innovative and enjoyable training method. One way to boost the attractiveness and effectiveness of an exergame is to individualize it with game adaptations. A physiological parameter that is often used to balance the physical challenge and intensity of exergames to the player’s fitness skills is the heart rate (HR). Therefore, researchers and designers often rely on age-based, maximum HR (HRmax) formulas originating from performance diagnostics. In combination with the player’s assessed real-time HR during an exergame session, the pre-determined HRmax is used to adapt the game’s challenge to reach a pre-defined HR and physical intensity level (in-exergame adaptations), respectively. Although the validity and reliability of these age-based HRmax formulas were proven in heterogeneous target populations, their use is still often criticized as HR is an individual parameter that is affected by various internal and external factors. So far, no study has investigated whether the formula-based pre-calculated HRmax compared to a standardized individually pre-assessed HRmax elicits different training intensities, training experiences, and flow feelings in an exergame. Therefore, we compared both variants for in-exergame adaptation with the ExerCube – a functional high-intensity interval training exergame – in healthy young adults. Comparing the results of the two conditions, no significant differences were found for HR parameters and perceived physical and cognitive exertion, nor for overall flow feelings and physical activity enjoyment. Thus, the formula-based in-exergame adaptation approach was suitable in the presented study population, and the ExerCube provided an equally reliable in-exergame adaptation and comparable exergame play experiences. We discuss our findings in the context of related work on exergame adaptation approaches and draw out some implications for future adaptive exergame design and research topics.

Prediction of endotracheal tube size using a printed three-dimensional airway model in pediatric patients with congenital heart disease: a prospective, single-center, single-group study.

BackgroundTo determine the correct size of endotracheal tubes (ETTs) for endotracheal intubation of pediatric patients, new methods have been investigated. Although the three-dimensional (3D) printing technology has been successful in the field of surgery, there are not many studies in the field of anesthesia. The purpose of this study was to evaluate the accuracy of a 3D airway model for prediction of the correct ETT size, and compare the results with a conventional age-based formula in pediatric patients.MethodsThirty-five pediatric patients under six years of age who were scheduled for congenital heart surgery were enrolled. In the pre-anesthetic period, the patient’s computed tomography (CT) images were converted to Standard Triangle Language (STL) files using the 3D conversion program. A Fused Deposition Modelling (FDM) type 3D printer was used to print 3D airway models from the sub-glottis to the upper carina. ETT size was selected by inserting various sized cuffed-ETTs to a printed 3D airway model.ResultsThe 3D method selected the correct ETT size in 21 out of 35 pediatric patients (60%), whereas the age-based formula selected the correct ETT size in 9 patients (26%).ConclusionsPrediction of the correct size of ETTs using a printed 3D airway model demonstrated better results than the age-based formula. This suggests that the selection of ETT size using a printed 3D airway model may be feasible for helping minimize re-intubation attempts and complications in patients with congenital heart disease and/or those with an abnormal range of growth and development.

Weight Is More Accurate than Gestational Age When Estimating the Optimal Endotracheal Tube Depth in Neonates.

Determining the optimal endotracheal tube (ETT) depth in neonates remains challenging for neonatologists. The guideline for optimal ETT depth is based on the patients’ weight or gestational age. However, there is a discrepancy in the suggested ETT depth between these two parameters. The aim of this retrospective study was to compare the recommended weight-based and age-based formulas for optimal ETT depth and obtain the optimal reference before intubation. Participants were assigned to group 1 if the recommended ETT insertion depth based on weight was concordant with the recommended depth based on gestational age, and to group 2 if the weight and age-based depth recommendations were discordant. After exclusion, 180 patients were included in the analysis. Results indicated that the predicted ETT depth suggested by age required more adjustment than by weight (p < 0.05). Furthermore, the required adjustment in the weight-based formula was smaller than the age-based formula (p < 0.05). Multivariate linear regression analysis revealed that weight was the key factor affecting the optimal depth (p < 0.001). These results imply that when there is a discrepancy in ETT depth between the weight-based and age-based recommendation, the weight-based one will be more accurate than the age-based one.

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

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

Point of care airway ultrasound to select tracheal tube and determine insertion depth in cleft repair surgery

We aimed to evaluate the efficacy of using airway ultrasonography to select the correct tracheal tube size and insertion depth in pediatric patients who underwent cleft repair surgery as a way to decrease airway complications and adverse events during perioperative periods. Fifty-one patients (age < 28 months) were consecutively divided into conventional (n = 28) and ultrasound (n = 23) groups. Tracheal tube size and insertion depth were determined using the age-based formula and auscultation in the conventional group, whereas using ultrasonographic measurement of subglottic diameter with auscultation and lung ultrasonography in the ultrasound group. We evaluated the initially selected tube size, insertion depth, ventilatory indices, and the incidence of airway complications and adverse events. Tube insertion depth (median [interquartile range]) was significantly greater in the ultrasound group than in the conventional group (13.5 cm [12.5–14.0] vs 13.0 cm [11.8–13.0], P = 0.045). The number of complications and adverse events was significantly higher in the conventional group than in the ultrasound group (32.1% vs 4.3%, P = 0.013). Airway ultrasound application could reduce airway-related complications and adverse events by determining the appropriate tracheal tube size and insertion depth.

Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy.

To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index. Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes. Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients. Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < -2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance.

The Utility of Ultrasound to Predict the Uncuffed Endotracheal Tube Size in Pediatric Population

Introduction: Due to contrasting evidence for and against the age-based formulas for calculation of correct size of endotracheal tube (ETT) in children, this prospective observational study aimed at comparison of ultrasonography (USG) and age-based formula for calculation of correct ETT size in children &lt;6 years of age. Materials and Methods: Following a sample size calculation of 63 children, children of &lt;6 years of age were recruited. Age-based formula (Cole's formula) was used for predicting ETT size. Cricoid diameter was measured using USG, and USG ETT was selected. Correct tube used for the patient was confirmed by air leak test. Agreement for correct size ETT with USG and age-based method was assessed using kappa value for intraclass correlation (ICC). Subgroup analysis was carried out for age, sex, and weight. Results: Sixty-six children with a mean age of 27.9 months were recruited. USG method was found to be correct in 44 patients (67%), whereas age-based method selected the correct tracheal tube size in 32% (21) of patients ( P &lt; 0.001). Agreement of ultrasound-based method with the correct size tube was 0.902, while the same for age-based formula method and correct ETT was 0.835 proving the superiority of the USG. On subgroup analysis, ultrasound-based tube selection was accurate in children &lt;1 year. Conclusions: With ICC of 0.902, ultrasound can be a useful tool for selecting pediatric ETT size as compared to age-based formula. This finding is significant, especially in children under the age of 1 year.

Pediyatrik Hastalarda Uygun Endotrakeal Tüp Çapının Belirlenmesi: Distal Radius Epifiz Çapının ve Subglottik Çapın Kullanımı

INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measurement as a surrogate parameter for endotracheal tube (ETT) size prediction in children. METHODS: Seventy-three children were intubated with cuffed ETT selected according to age-based formula. Transvers diameter of epiphysis of distal radius and subglottic diameter of trachea were measured by ultrasound (US). Correlation between the outer diameter of best-fit endotracheal tube and transvers diameter of both radius epiphysis and subglottic diameter were calculated. The need for tube exchange, time for ultrasound (US) measurements and the ease level of measurements were compared. RESULTS: First attempt success at intubation was 83.6%. The correlation of the epiphysis diameter of the distal radius and best-fit ETT was significant (p&lt;0.001, r= 0.619, r2=0.383, 95% CI=0.419-0.838). Similarly the correlation of subglottic tracheal diameter and best-fit ETT was significant (p&lt;0.001, r=0.744, r2=0.553, 95% CI=0.678-825). Estimated ETT sizes according to radial epiphysis diameter and subglottic diameter were optimal in 82.2% and 94.5% respectively. Time for the US measurements of radial epiphysis and subglottic area were 38.3±9.6 and 24.9±4.6 seconds respectively (p&lt;0.001). The level of ease of US measurements were rated for radial epiphysis as 6 (5-9) and for subglottic area as 8 (7-9) (p&lt;0.001). DISCUSSION AND CONCLUSION: US measured transverse diameter of distal radius epiphysis resulted in similar success rate to age-based formula in our child population. Subglottic diameter measured by US estimates ETT size more accurately; it is also less time consuming and easier.

Age-based Estimation of Contact Lens Base Curve in Filipino Infants

Objective. To create an age-based formula to estimate the base curve needed for contact lens fitting using measured central corneal curvature (CCC) with a handheld auto keratometer from ophthalmologically normal infants. Methods. This is a prospective cross-sectional study involving 70 ophthalmologically normal full-term infants aged 0 to 12 months. The infants were divided into four groups: 0–3 months, &gt;3–6 months, &gt;6–9 months and &gt;9–12 months. CCC was measured with a handheld auto keratometer and was used to compute for the base curve. Differences in CCC between the four groups were measured and linear regression models were used for formula creation. Results. The mean CCC was highest in group 1 at 45.5 ±2.4 diopters (D). These values slowly decreased as age increased. A formula predictive of the base curve based on the infants age was derived using linear regression analysis. It predicted that for every month increase in age, there is a 0.063 millimeter increase in the base curve (p&lt;0.001). Conclusion. Infant CCC is highest at birth and gradually decreases as age increases. The formula can predict the base curve needed for contact lens fitting in infants without the need for a handheld autokeratometer.

Development and validation of a weight estimation tool for paediatric emergency care

ObjectiveTo develop and validate a weight estimation tool applicable in paediatric emergency care. MethodsUsing anthropometric data from a computerized database of the primary health care paediatric services, Bilbao (Basque Country, Spain), linear regression models were developed with the objective of estimating weight from height. Subsequently, these models were prospectively validated using a consecutive sample of children attended in the emergency department of two tertiary hospitals. Estimated weights were compared with actual weights, calculating the intraclass correlation coefficient (ICC), mean difference and percentages of estimations falling within 10% and 20% of the actual weight. ResultsUsing anthropometric data from 15,522 children two weight predictive formulas were developed (Bilbao Formulas). The formulas were validated on a sample of 780 children and estimated weight values with a high degree of intraclass correlation with the real weight (ICC=.93, p<.001) and a mean difference of .63 (SD: 4.3). The percentages of estimations falling within 10% and 20% of the actual weight of the child was 62.2% (95% CI: 58.7–65.6) and 93.1% (95% CI: 91.1–94.8), respectively. Weight estimations were more accurate using Bilbao Formulas than other classical formulas. ConclusionsBilbao Formulas would be a valid tool for estimating weight in children in the emergency department and predict weight more accurately than other more commonly used age-based formulas.

Validation of pediatric height estimation formulae in suburban communities in South-east Nigeria: a cross-sectional study.

SummaryBackgroundHeight measurement is one of the common essential anthropometric measurements in clinical pediatrics. The most accurate method of determining a child’s height is to measure the height. However, in emergency situations and some resource limited settings, obtaining the actual height of a child may not be feasible hence the need to estimate. The most common age-based formulae for height estimation in children is the Nelson-Wheech formula, 6n + 77 where n = age in years. The accuracy of this height estimation formulae has not been assessed in a developing setting like ours with high prevalence of malnutrition. This study therefore sought to evaluate the accuracy of the height estimation formula in children in communities across Enugu southeast Nigeria.MethodChildren 2-12 years old who met the inclusion criteria were enrolled over 12 months from three of the 17 Local Government Area of Enugu State. Height was measured using a standard stadiometer and estimated height was calculated 6n + 77. Data collected was analyzed using SPSS.ResultOf the 4046 children enrolled, majority (86.1%) were of normal height. The formula underestimated height of children in the two, 3, 4, 5, 6, 7, 9 and 10 years old categories by a factor of 1.2%-10.0% while overestimating height in 8-year old children by 5.1%, 11-year old by 0.2% and 12-year by 2.9%. Overall, the estimated height using the formula was within ± 10% agreement of the actual height of surveyed children in 77.0% of children surveyed.ConclusionThe 6n + 77 formula is a reasonable but not entirely accurate for height estimation for children in our setting.

Accuracy of weight estimation methods in adults, adolescents and children: a prospective study

IntroductionWeight estimation of both adult and paediatric patients is often necessary in emergency or low-resource settings when it is not possible to weigh the patient. There are many methods for...

Prediction of appropriate formula for nasotracheal tube size in developmental disability children.

Developmental disability children have differences in growth. Therefore, tube size selection is important for nasotracheal intubation. In our previous study for healthy children undergoing dental surgery, height was the most suitable factor to predict nasotracheal tube size. The aim of this study was to find the most suitable formula for selection of nasotracheal tube size for them, retrospectively. Developmental disability children aged 2 to 10 years were included in this study. They were intubated nasotracheally from April 2012 until May 2017. Their actually intubated tube sizes were checked. The predicted tube sizes were calculated according to the formulas by the backgrounds: the diameter of the trachea at the 6th cervical (C6), 7th cervical (C7), and 2nd thoracic vertebrae (T2) in X-ray. The actually intubated tube sizes were compared with predicted sizes. Data were analyzed using Spearman's regression analysis. The tube sizes with 5.0, 5.5, and 6.0 mm ID were intubated in 75 patients. The age-based formula was the most suitable; the correlation coefficients (r2) were 0.9027 (vs age), 0.5434 (vs height), 0.3779 (vs weight), 0.0785 (vs C6), 0.2279 (vs C7), and 0.3065 (Th2) (p < 0.01). However, 0.5-mm smaller size tubes were more frequently intubated actually. Their correspondence rate to the predicted size was 48% (5.0 mm), 52% (5.5 mm), and 39% (6.0 mm), respectively. The age-based formula could be the most suitable for predicting nasotracheal tube size in developmental disability children aged 2 to 10 years. One smaller size by the age formula was most suitable at first trial tube. The present data indicate that the selection of nasotracheal tube using one smaller size by the age formula (ID = 4 + age [years]/4) might be useful for developmental disability children.

The utility of pediatric age-based weight estimation formulas for emergency drug dose calculations in obese children.

ObjectivesIn obese children, when drug therapy is required during emergency care, an estimation of ideal body weight is required for certain drug dose calculations. Some experts have previously speculated that age‐based weight estimation formulas could be used to predict ideal body weight. The objectives of this study were to evaluate how accurately age‐based formulas could predict ideal body weight and total body weight in obese children.MethodsThree age‐based weight estimation formulas were evaluated in a secondary analysis, using a pooled sample of children from 3 academic emergency departments in South Africa. The estimates produced by the 3 formulas (and the PAWPER XL tape as a control) were compared against measured total body weight and ideal body weight. The percentages of estimates falling within 10% of the standard weight were used as the primary outcome measure (PW10).ResultsThis study included 1026 children. For ideal body weight estimations in obese children, the old Advanced Life Support formula, the new Advanced Life Support formula, and the Best Guess formula achieved PW10s (with 95% confidence intervals [CIs]) of 29% (27.2%, 30.8%), 41.4% (38.9%, 43.9%), and 48.3% (45.3%, 51.3%), respectively. For total body weight estimations, the formulas achieved PW10s of 3.6% (3.4%, 3.8%), 5.2% (4.9%, 5.5%), and 19.0% (17.8%, 20.2%). The PAWPER XL tape achieved an accuracy of ideal body weight estimation of 100% (93.9%, 100%) and total body weight estimation of 49.7% (46.7%, 52.7%) in obese children.ConclusionsThe age‐based formulas were substantially less accurate at estimating total body weight and ideal body weight than existing length‐based methods such as the PAWPER XL tape, and should not be used for this purpose.