Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus

Abstract

BackgroundThe Broselow tape (BT) has been shown to estimate weight poorly primarily because of variations in body habitus. The manufacturers have suggested that a visual assessment of habitus may be used to increase its performance. This study evaluated the ability of habitus-modified models to improve the accuracy thereof.MethodsA post hoc analysis of prospectively collected data from four hospitals in Johannesburg, South Africa, on a population of 1,085 children. Sixteen a priori models generated a modified weight estimation or drug dose based on the BT weight and a gestalt assessment of habitus.ResultsThe habitus-modified method suggested by the manufacturer did not improve the accuracy of the BT. Five dosing and four weight-estimation models were identified that markedly improved dosing and weight estimation accuracy, respectively. The best dosing model improved dosing accuracy (doses within 10% of correct dose) from 52.0 to 69.6% and reduced critical dosing errors from 16.5 to 4.3%. The best weight-estimation model improved accuracy from 59.4 to 81.9% and reduced critical errors from 11.8 to 1.9%.ConclusionThe accuracy of the BT as a drug-dosing and weight-estimation device can be substantially improved by including an appraisal of body habitus in the methodology.

A comparison of four weight estimation systems for paediatric resuscitation

“…This is in keeping with numerous studies done in South Africa and internationally showing the tape's inaccuracy in children at extremes of weights. 6,12,13 Despite these improvements, the habitus modified Broselow Tape only performed with acceptable accuracy in the average weight subgroup but failed to reproduce this in all the other categories. Its worst performance was seen in the underweight subgroup, with a significantly large bias to overestimate their weight.…”

“…5 The accuracy of this technique has only been evaluated once before. 6 As a result of the limitations of length-based weight estimation, Wells et al developed a dual length-and habitusbased weight estimation tool, the PAWPER (Paediatric Advanced Weight Prediction in the Emergency Room) tape, which takes body habitus into account when estimating weight. It allows the examiner to adjust the weight estimation up or down depending on the child's habitus.…”

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

“…It also explains why the tape predicted TBW well in children of "normal" habitus, but poorly in all others. This is why researchers have successfully proven the possibility of using alternative methods of habitus assessment to improve the accuracy of the Broselow tape [27,28].…”

Validation of two pediatric resuscitation tapes

“…1,8 Thus, it is being compared to newer weight estimation methodologies of dual length-and habitus-based methods like the Pediatric Advanced Weight Prediction in the Emergency Room (PAW-PER) tape. 6,9 Data on weight estimation using the Broselow tape were done on the western population, and there have been few studies done in Malaysia, 8 Philippines (Castor F, Cu J, unpublished data, 2017), Singapore, 10 and Thailand. 11 To date, there was no literature published on the validation of PAWPER weight estimation systems among the Southeast Asian population.…”

“…11 To date, there was no literature published on the validation of PAWPER weight estimation systems among the Southeast Asian population. With the conflicting results of the use in extremes of weight and limitation in the study population, [1][2][3][4][5][6][7][8][9][10] it is relevant to further determine the accuracy and precision of these pediatric emergency tapes. This study is the first to use both the Broselow and PAWPER weight estimation methods among Filipino children.…”