Introduction:The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined.Study Objective:The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation.Methods:This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care children’s hospital from January 1, 2021 through June 30, 2021. Demographic data, ED visit information, prehospital weight estimation, and medication dosing were collected and analyzed. Scale-based weight from the ED was used as the standard for comparison.Results:A total of 509 patients <13 years of age were included in this study. The EMS providers using the Broselow method estimated patient weight to within +/-10% of ED scale weight in 51.3% of patients. When using the Handtevy method, the EMS providers estimated patient weight to within +/-10% of ED scale weight in 43.7% of patients. When comparing the Handtevy versus Broselow method of prehospital weight estimation, there was no significant association between method and categorized weight discrepancy (over, under, or accurate estimates – defined as within 10% of ED scale weight; P = .25) or percent weight discrepancy (P = .75). On average, prehospital weight estimation was 6.33% lower than ED weight with use of the Handtevy method and 6.94% lower with use of the Broselow method.Conclusion:This study demonstrated no statistically significant difference between the use of the Handtevy or Broselow methods with respect to prehospital weight estimation. While further research is necessary, these results suggest similar field performance of the Broselow and Handtevy methods.
Practice Problem: Secondary transfers to pediatric centers have increased by 25% due to the regionalization of specialty care. Low pediatric volume and the lack of access to pediatric subspecialty confounds the need for transfer requests to comprehensive children’s hospitals. Referring hospitals rely on pediatric teams to determine the level of service and mode of transportation decisions due to a lack of comfort in caring for and managing pediatric patients. PICOT: This project was guided by the following question. In pediatric patients transferring from other healthcare facilities to a comprehensive children’s hospital (P), does the implementation of a nurse-led pediatric illness severity scoring tool (I) versus traditional phone triage (C), increase recognition and notification of ICU level patients (O) in 8-weeks (T)? Evidence: Triage transport tools have been studied in the pediatric population and are relied on to determine acuity and predict admission needs. Acuity tools allow for consistent resource allocation and improved transfers by removing the subjectiveness of physical findings and converting the assessments into objective metrics needed to make safe transport and admission decisions. Intervention: A pediatric transport acuity tool was implemented to standardize the reporting framework and was scored to identify high-acuity patients requiring transport for definitive care. Outcome: Improved identification of ICU-level patients requiring transport to a pediatric hospital from 63% pre-intervention to 97% post-intervention. Conclusion: This project increased recognition of ICU-level pediatric patients through use of the TRAP tool and also identified a broader impact, which is exposing referring hospitals to a triage tool that assists outside providers in identifying acutely ill pediatric patients.
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