The accuracy of emergency weight estimation systems in children—a systematic review and meta-analysis

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Abstract

The safe and effective administration of fluids and medications during the management of medical emergencies in children depends on an appropriately determined dose, based on body weight. Weight can often not be measured in these circumstances and a convenient, quick and accurate method of weight estimation is required. Most methods in current use are not accurate enough, but the newer length-based, habitus-modified (two-dimensional) systems have shown significantly higher accuracy. This meta-analysis evaluated the accuracy of weight estimation systems in children. Articles were screened for inclusion into two study arms: to determine an appropriate accuracy target for weight estimation systems; and to evaluate the accuracy of existing systems using standard meta-analysis techniques. There was no evidence found to support any specific goal of accuracy. Based on the findings of this study, a proposed minimum accuracy of 70% of estimations within 10% of actual weight (PW10 > 70%), and 95% within 20% of actual weight (PW20 > 95%) should be demonstrated by a weight estimation system before being considered to be accurate. In the meta-analysis, the two-dimensional systems performed best. The Mercy method (PW10 70.9%, PW20 95.3%), the PAWPER tape (PW10 78.0%, PW20 96.6%) and parental estimates (PW10 69.8%, PW20 87.1%) were the most accurate systems investigated, with the Broselow tape (PW10 55.6%, PW20 81.2%) achieving a lesser accuracy. Age-based estimates achieved a very low accuracy. Age- and length-based systems had a substantial difference in over- and underestimation of weight in high-income and low- and middle-income populations. A benchmark for minimum accuracy is recommended for weight estimation studies and a PW10 > 70% with PW20 > 95% is suggested. The Mercy method, the PAWPER tape and parental estimates were the most accurate weight estimation systems followed by length-based and age-based systems. The use of age-based formulas should be abandoned because of their poor accuracy.

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The online version of this article (10.1186/s12245-017-0156-5) contains supplementary material, which is available to authorized users.

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Most cited references 168

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Meta-analysis: Neither quick nor easy

Nancy Berman, Robert Parker (2002)

Background Meta-analysis is often considered to be a simple way to summarize the existing literature. In this paper we describe how a meta-analysis resembles a conventional study, requiring a written protocol with design elements that parallel those of a record review. Methods The paper provides a structure for creating a meta-analysis protocol. Some guidelines for measurement of the quality of papers are given. A brief overview of statistical considerations is included. Four papers are reviewed as examples. The examples generally followed the guidelines we specify in reporting the studies and results, but in some of the papers there was insufficient information on the meta-analysis process. Conclusions Meta-analysis can be a very useful method to summarize data across many studies, but it requires careful thought, planning and implementation.

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A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group.

D S Lubitz, J S Seidel, L Chameides … (1988)

Drug dosages used during pediatric emergencies and resuscitation are often based on estimated body weight. The Broselow Tape, a tape measure that estimates weight and drug dosages for pediatric patients from their length, has been developed to facilitate proper dosing during emergencies. In our study, 937 children of known weight were measured with this tape. Weight estimates generated by the tape were found to be within 15% error for 79% of the children. The tape was found to be extremely accurate for children from 3.5 to 10 kg, and from 10 to 25 kg. Regression lines of estimated compared with actual weight for these children have slopes of 0.98 and 0.96, respectively, not significantly different from the ideal slope of 1.00 (P = 28 and .13). Accuracy was significantly decreased for measured children who weighed more than 25 kg. In a separate group of children (n = 53), the tape was shown to be more accurate than weight estimates made by residents and pediatric nurses (P less than .0001). Use of the Broselow Tape is a simple, accurate method of estimating pediatric weights and drug doses and eliminates the need for memorization and calculation.

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Kimberly Hickey, Arno L. Zaritsky, … (2010)

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Author and article information

Contributors

Mike Wells:

ORCID: http://orcid.org/0000-0002-4520-2007

+27 82 491 0369 , mike.wells@emergencymedicine.co.za

Lara Nicole Goldstein: drg666@gmail.com

Alison Bentley: allison.bentley@wits.ac.za

Journal

Journal ID (nlm-ta): Int J Emerg Med

Journal ID (iso-abbrev): Int J Emerg Med

Title: International Journal of Emergency Medicine

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1865-1372

ISSN (Electronic): 1865-1380

Publication date (Electronic): 21 September 2017

Publication date PMC-release: 21 September 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 29

Affiliations

[1 ]ISNI 0000 0004 1937 1135, GRID grid.11951.3d, Division of Emergency Medicine, Faculty of Health Sciences, , University of the Witwatersrand, ; 7 York Road, Parktown, Johannesburg, 2193 South Africa

[2 ]Postnet Suite 429, Private Bag X1510, Glenvista, 2058 South Africa

Author information

Mike Wells http://orcid.org/0000-0002-4520-2007

Article

Publisher ID: 156

DOI: 10.1186/s12245-017-0156-5

PMC ID: 5608658

PubMed ID: 28936627

SO-VID: e5767a9e-5bfb-4f73-a1e0-53f341b5b238

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.