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 paediatric weight estimation, but no standard methods for adults. PAWPER and Mercy tapes are used in children, but have not been assessed in adults. The primary aim of this study was to assess weight estimation methods in patients of all ages.MethodsPatients were prospectively recruited from emergency and outpatient departments in Kigali, Rwanda. Participants (or guardians) were asked to estimate weight. Investigators collected weight, height, mid-arm circumference (MAC) and humeral-length data. In all participants, estimates of weight were calculated from height and MAC (PAWPER methods), MAC and humeral length (Mercy method). In children, Broselow measurements and age-based formulae were also used. The primary outcome measure was the proportion of estimates within 20% of actual weight (p20).ResultsWe recruited 947 participants: 307 children, 309 adolescents and 331 adults. For p20, the best methods were: in children, guardian estimate (90.2%) and PAWPER XL-MAC (89.3%); in adolescents, PAWPER XL-MAC (91.3%) and guardian estimate (90.9%); in adults, participant estimate (98.5%) and PAWPER XL-MAC (83.7%). In all age groups, there was a trend of decreasing weight estimation with increasing actual weight.ConclusionThis prospective study of weight estimation methods across all age groups is the first adult study of PAWPER and Mercy methods. In children, age-based rules performed poorly. In patients of all ages, the PAWPER XL-MAC and guardian/participant estimates of weight were the most reliable and we would recommend their use in this setting.
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.
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