Comparing the usability of paediatric weight estimation methods: a simulation study

Marlow, Robin; Wood, Dora; Lyttle, Mark D

doi:10.1136/archdischild-2018-314873

Cited by 3 publications

(14 citation statements)

References 16 publications

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“…Some of the most commonly used weight estimation methods include formulas based on age, the Broselow Pediatric Emergency Tape, and newer dual length and habitus-based systems, such as the Mercy Method and the Pediatric Advanced Weight Prediction in the Emergency Room, Extra-large/Extra-long (PAWPER XL) Tape. Some of these methodologies, such as agebased formulas, have already been shown to be inaccurate in previous studies, but the underlying causes have not been well-studied [5][6]. Other techniques, such as the PAWPER XL Tape, have been shown to be accurate in some studies [7][8][9] but could still potentially be improved, especially as other studies have shown inconsistent accuracy in obese populations [10][11], primarily as a result of inaccurate habitus assessment.…”

Section: Introductionmentioning

confidence: 99%

How and Why Paediatric Weight Estimation Systems Fail - A Body Composition Study

Wells¹,

Goldstein²

2020

Cureus

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Background Weight estimation during medical emergencies in children is essential, but fraught with errors if the wrong techniques are used, which may result in critical drug dosing errors. Individualised weight estimation is required to allow for accurate dosing in underweight and obese children in particular. This study was designed to evaluate the associations between weight estimations from different systems and body composition in order to establish how and why they may perform well or poorly. Methods A convenience sample of 332 children aged from one month to 16 years had weight estimations using four age-based formulas: the Broselow™ Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL), the Mercy Method, and the Pediatric Advanced Weight Prediction in the Emergency Room, Extra-large/Extra-long Tape (PAWPER XL) Tape. They also had an assessment of body composition using dual x-ray absorptiometry (DXA). The weight estimates were compared against total body weight (TBW), calculated ideal body weight (IBW), and DXA-measured fat-free mass (FFM). Analyses of associations between age, length, weight estimation outcomes, and body composition were performed. Results Age-based formulas were very inaccurate because of the erratic relationship between age and body composition. The Broselow tape estimated IBW well in obese children because of the strong relationship between length and fat-free mass. It predicted TBW poorly in underweight and obese children, however, because of the poor relationship between length and fat mass. The Mercy Method's performance was unrelated to body composition, but estimated TBW reasonably well and could not predict IBW or FFM. The PAWPER XL Tape's performance was the most closely associated with body composition and, therefore, achieved an acceptable accuracy for estimations of TBW, IBW, and FFM. Conclusions Of the systems evaluated, the PAWPER XL Tape has the best association with body composition and the most accurate estimations of TBW, IBW, and FFM.

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Section: Introductionmentioning

confidence: 99%

How and Why Paediatric Weight Estimation Systems Fail - A Body Composition Study

Wells¹,

Goldstein²

2020

Cureus

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“…This findings in this study can also not be generalized to age-based formula systems: although virtual studies may be able to evaluate the potential accuracy of these formulas, not enough work has been done to even speculate meaningfully on the impact of human and patient factor errors on the use of age-formulas in emergencies. Furthermore, current evidence does not support the use of age-formulas in terms of both accuracy and usability [5] , [19] .…”

Section: Discussionmentioning

confidence: 74%

“…Virtual weight estimation studies and those conducted in non-clinical (or non-simulated clinical) conditions may not provide an accurate indication of the usability of a weight estimation system or its accuracy under adverse conditions. In a recent meta-analysis, only seven of the 150 weight estimation studies included were conducted in real or simulated paediatric emergencies with two further articles published subsequently [2] , [4] , [5] . This means that there is very little evidence on the actual functioning of weight estimation systems when exposed to human and patient factor errors.…”

Section: Discussionmentioning

confidence: 99%

“…The limited evidence that is available for the Broselow tape, the Mercy method and the PAWPER XL tape suggests that undertrained users are substantially less accurate than experienced users during simulated emergencies [4] . There is also evidence that age-based formulas cannot be remembered during emergencies, the calculations cannot be performed accurately and might be unusable as a result [5] . Similarly, adverse patient position and cooperation – common during real emergencies – can have significant effects on the accuracy of certain weight estimation systems, particularly the Broselow tape and the Mercy method [4] .…”

Section: Discussionmentioning

confidence: 99%

“…While it has been assumed that virtual studies are equivalent to prospective, real-life studies, there is no evidence to support this assumption. In fact, there is good evidence that human factor errors and patient factor errors may contribute significantly to differences in the performance of weight estimation systems under virtual, real and emergency circumstances [3] , [4] , [5] . It is also quite possible that technical considerations may contribute substantially to differences in outcomes between real and virtual studies (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Are “virtual” paediatric weight estimation studies valid?

Wells

Goldstein

2019

African Journal of Emergency Medicine

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Introduction “Virtual” studies account for nearly one-third of all published weight estimation articles, but the validity of these virtual studies has never been evaluated. It is important to establish this validity in order to decide whether the results of these studies can be applied to real-world usage. The objectives of this study were to evaluate the accuracy of virtual weight estimates using the Broselow and PAWPER tapes and compare these to actual real-life estimates from the tapes. Methods Virtual weights were generated for the Broselow and PAWPER tapes using anthropometric data from a sample of 1385 children for whom actual Broselow and PAWPER tape weights were available. The accuracy of the virtual and real-life estimates was compared against each child’s actual weight. The agreement of the virtual and real estimates was also evaluated. Results The percentage of weight estimates within 10% of actual weight were 57.9% and 59.3% for the real and virtual Broselow tapes respectively and 76.6% and 78.4% for the real and virtual PAWPER tapes respectively. The Cohen’s kappa for the real and virtual Broselow and PAWPER tapes was 0.65 and 0.64 respectively, which indicated substantial agreement. Conclusions The virtual and real weight estimates had very similar accuracy outcomes for both tapes in this study. However, if virtual studies are used, they should be followed by real-life studies in order to assess the impact of human and patient factor errors on the accuracy of the weight estimation systems.

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Prescribing in a paediatric emergency: A PERUKI survey of prescribing and resuscitation aids

Jahn

Roland

et al. 2020

Acta Paediatrica

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Aim The aim was to investigate the use of paper‐based and electronic prescribing and resuscitation aids in paediatric emergency care from a departmental and individual physician perspective. Methods A two‐stage web‐based self‐report questionnaire was performed. In stage (i), a lead investigator at PERUKI sites completed a department‐level survey; in stage (ii), individual physicians recorded their personal practice. Results The site survey was completed by 46/54 (85%) of PERUKI sites. 198 physicians completed the individual physicians' survey. Individual physicians selected the use of formulary apps for checking of medication dosages nearly as often as hardcopy formularies. The APLS WETFLAG calculation and hardcopy aids were widely accepted in both surveys. A third of sites accepted and half of the individual physicians selected resuscitation apps on the personal mobile device as paediatric resuscitation aids. Conclusion Our survey shows a high penetrance of the British National Formulary app, a success of NHS digital policy and strategy. Despite potential advantages, many physicians in our survey do not use resuscitation apps. Reluctance to engage with apps is likely to be multifactorial and includes human factors. These obstacles need to be overcome to create a digital healthcare culture.

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Comparing the usability of paediatric weight estimation methods: a simulation study

Abstract: In this exploratory study under psychological stress none of the methods of weight estimation were free from error. Reference tables were the fastest method and also had the largest errors and should be designed to minimise the risk of picking errors.

Cited by 3 publications

References 16 publications

How and Why Paediatric Weight Estimation Systems Fail - A Body Composition Study

How and Why Paediatric Weight Estimation Systems Fail - A Body Composition Study

Are “virtual” paediatric weight estimation studies valid?

Prescribing in a paediatric emergency: A PERUKI survey of prescribing and resuscitation aids

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