Weighing the Pediatric Patient During Trauma Resuscitation and Its Concordance With Estimated Weight Using Broselow Luten Emergency Tape

Department of Pediatrics, Arizona Children's Center at Maricopa Medical Center, Phoenix, AZ 85008, USA.
Pediatric emergency care (Impact Factor: 1.05). 05/2012; 28(6):544-7. DOI: 10.1097/PEC.0b013e318258ac2e
Source: PubMed


Obtaining an accurate weight is crucial during pediatric trauma/medical resuscitation. Currently, length-based weight estimations are used. Study objective was to assess feasibility of obtaining actual weights of children during trauma resuscitation and study its concordance with length-based estimated weight using the Broselow Pediatric Emergency Tape.
Pediatric trauma patients 0 to 14 years old presenting to a tertiary care pediatric trauma center between November 2008 and October 2009 were enrolled prospectively. Length-based weight estimation was done on patient arrival using the Broselow tape; in addition, an actual patient weight was recorded using the trauma stretcher integrated weighing scale.
Two hundred thirty-one patients were eligible and enrolled. Weights were recorded in 145 children (63.2%). In 27 patients (18.6%) whose body length exceeded Broselow tape range, weight was measured using stretcher scale only. The remaining 118 patients (mean age, 5.0 [SE ± 0.3] years; 67% male) were used for correlation analysis. There was good correlation (Pearson correlation coefficient, r = 0.86) between estimated weight and measured weight. However, Bland-Altman analysis showed mean bias +2.6 kg (95% confidence interval [CI], 1.6-3.6 kg); lower/upper limits of agreement were -8.3 kg (CI, -10.0 to -6.6 kg) and 13.5 kg (CI, 11.7-15.2 kg).
It is possible to obtain an actual patient weight during pediatric trauma resuscitation. Length-based estimated weight using Broselow tape underestimated weight by 2.6 kg; the mean error was greatest in the highest weight category.

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    ABSTRACT: Study objective: Validated methods for weight estimation of children are readily available in developed countries; however, their utility in developing countries with higher rates of malnutrition and infectious disease is unknown. The goal of this study is to determine the validity of a height-based estimate, the Broselow tape, compared with age-based estimations among pediatric patients in Western Kenya. Methods: A prospective cross-sectional study of all sick children presenting to the emergency department of a government referral hospital in Eldoret, Kenya, was performed. Measured weight was compared with predicted weights according to the Broselow tape and commonly used advanced pediatric life support (APLS) and Nelson's age-based formulas. A Bland-Altman analysis was used to determine agreement between each method and actual weight. The method for weight prediction was determined a priori to be equivalent to the actual weight if the 95% confidence interval for the mean percentage difference between the predicted and actual weight was less than 10%. Results: Nine hundred sixty-seven children were included in analysis. The overall mean percentage difference for the actual weight and Broselow predicted weight was -2.2%, whereas APLS and Nelson's predictions were -5.2% and -10.4%, respectively. The overall agreement between Broselow color zone and actual weight was 65.5%, with overestimate typically occurring by only 1 color zone. Conclusion: The Broselow tape and APLS formula predict the weights of children in western Kenya. According to its better performance, ease of use, and provision of drug dosing and equipment size, the Broselow tape is superior to age-based formulas for estimation of weight in Kenyan children.
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    ABSTRACT: Obtaining an actual weight is critical to accurate medication dosing. Knowledge of length/height is critical to equipment sizing. Rapid and accurate measurement of both upon arrival at the emergency department increases patient safety and staff comfort in the case of a decompensating child requiring resuscitation. Having a process in place that works with the layout, medical record, and budget of the department increases safety for the patient and may improve outcomes, and if the process is led by staff champions, acceptance of the process may be faster. Regardless of the actual method, patient safety and staff satisfaction can be improved with a simple process that prepares for an emergency in pediatric care.
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    ABSTRACT: Introduction: During paediatric resuscitation it is essential to be able to estimate the child's weight as it determines drug doses and equipment sizes. Age and length-based estimations exist, with age-based estimations being especially useful in the preparation phase and the length-based Broselow tape having weight-based drug doses and equipment already assigned via a colour code system. The aim of this study was to compare the actual recorded weights of Australian children to the predicted weights using the original and updated APLS, Luscombe and Owens and Best Guess formulae and the Broselow tape. Method: A retrospective observational study of children attending an Australian tertiary children's hospital. Results: From 49,565 patients extracted from the database, 37,114 children with age and weight and 37,091 children with age and height recorded were included in the analysis. Best Guess was the most accurate, with the smallest overall mean difference 0.86 kg. For <1 year old, Broselow tape was the most accurate (mean difference -0.43 kg), Best Guess was the most accurate for ages 1-5 years and 11-14 years (mean difference 0.27 and 0.20 kg respectively), and the updated APLS formula was the most accurate for 6-10 year-old (mean difference 0.42 kg). The Broselow tape was able to only classify 48.9% of children into the correct weight colour band. Conclusions: For an age-based weight estimation, in infants less than one year the new APLS formula is the most accurate and over one year the Best Guess formulae should be used.
    Full-text · Article · Dec 2013 · Resuscitation
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