Accuracy of the Broselow Tape in South Sudan, “The Hungriest Place on Earth”

Abstract

Objectives: The Broselow tape is a length-based tool used for the rapid estimation of pediatric weight and was developed to reduce dosage-related errors during emergencies. This study seeks to assess the accuracy of the Broselow tape and age-based formulas in predicting weights of South Sudanese children of varying nutritional status.Methods: This was a retrospective, cross-sectional study using data from existing acute malnutrition screening programs for children less than 5 years of age in South Sudan. Using anthropometric measurements, actual weights were compared with estimated weights from the Broselow tape and three age-based formulas. Mid-upper arm circumference was used to determine if each child was malnourished. Broselow accuracy was assessed by the percentage of measured weights falling into the same color zone as the predicted weight. For each method, accuracy was assessed by mean percentage error and percentage of predicted weights falling within 10% of actual weight. All data were analyzed by nutritional status subgroup.Results: Only 10.7% of malnourished and 26.6% of nonmalnourished children had their actual weight fall within the Broselow color zone corresponding to their length. The Broselow method overestimated weight by a mean of 26.6% in malnourished children and 16.6% in nonmalnourished children (p < 0.001). Age-based formulas also overestimated weight, with mean errors ranging from 16.2% over actual weight (Advanced Pediatric Life Support in nonmalnourished children) to 70.9% over actual (Best Guess in severely malnourished children). Conclusions:The Broselow tape and age-based formulas selected for comparison were all markedly inaccurate in both the nonmalnourished and the malnourished populations studied, worsening with increasing malnourishment. Additional studies should explore appropriate methods of weight and dosage estimation for populations of low-and low-to-middle-income countries and regions with a high prevalence of malnutrition.ACADEMIC EMERGENCY MEDICINE 2016;23:21-28

A validation study of the PAWPER XL tape: accurate estimation of both total and ideal body weight in children up to 16 years of age

“…Although the Broselow tape accurately estimated weight in children of average habitus (those with a TBW similar to IBW), it was critically inaccurate in underweight and overweight children and failed to estimate weight within 20% of actual weight in every obese child in this study. This has been frequently reported previously, with potentially dangerous overestimation of weight in low-and middle-income countries and substantial underestimation of weight in high-income populations [14][15][16][17][18]. The accuracy was highest in the youngest children, falling off significantly in children >25kg.…”

Development and validation of a method to estimate body weight in critically ill children using length and mid-arm circumference measurements: The PAWPER XL-MAC system

“…[1] Estimated weights have been shown to be extremely inaccurate in many settings, however, with some studies in underweight and obese populations having shown weight estimations to be inaccurate in up to 85% of children. [2][3][4][5] These are dangerous results that would inevitably lead to many critical medication errors. Even in populations without extreme prevalences of underweight or obesity, many commonly used methods, such as age-based formulae, are frequently inaccurate in more than half the children in whom they are used.…”

Accuracy of Broselow tape in estimating the weight of the child for management of pediatric emergencies in Nepalese population

“…Using newer edition of the tape presumably creates a greater error in estimating the weight of our populations compared to prior edition as it has been modified to minimize weight underestimation in obese children in the USA. There are studies done in various parts of the world providing the adaptability and efficiency of the Broselow tape in measuring the weight of children [10,11,25] while other studies had contradictory conclusions [13][14][15][16][17]22]. Studies from Kenya [10] and South Africa [10,25] showed that the Broselow tape estimated weights varied only minimally from the actual weight.…”

“…In a simulated pediatric emergency, color coding significantly reduced the deviation from recommended doses [8]. The studies done in various parts of the world have shown that the Broselow tape accurately measured the weight of children [10][11][12] while some studies showed it to be inaccurate [13][14][15][16][17]. The scenario is quite different in low-income countries like Nepal [15,18,19].…”