Ontario children have outgrown the Broselow tape

Abstract

Objective: The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a wellestablished length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort. Methods: Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; agreement and percent error (PE) were also calculated. Results: A total of 6,361 children (46.2% female) were included in the study. The median age was 3.9 years (interquartile range [IQR] 1.56-7.67 years), weight was 17.2 kg (IQR 11.6-25.4 kg), and height was 103.5 cm (IQR 82-124.4 cm). Although the BT weight estimate correlated with the actual weight (r 5 0.95577, p , 0.0001), the BT underestimated the actual weight by 1.62 kg (7.1% 6 16.9% SD, 95% CI 226.0-40.2). The BT had an $ 10% PE 43.7% of the time. Conclusions: Although the BT remains an effective method for estimating pediatric weight, it was not accurate and tended to underestimate the weight of Ontario children. Until more accurate measurement tools for emergency departments are developed, physicians should be aware of this discrepancy. RÉ SUMÉObjectif: L'é chelle de Broselow (Broselow Tape [ Bien que les poids estimé s à l'aide de l'é chelle de Broselow aient é té corré lé s avec les poids ré els (r 5 0,95577, p , 0,0001), l'é chelle de Broselow a sous-estimé le poids ré el de 1,62 kg (7,1 % 6 16,9 % é cart-type, IC à 95 %: 26,0 à 40,2). L'é chelle de Broselow avait un $ 10 % PE 43,7 % du temps. Conclusions: Bien que l'é chelle de Broselow reste une mé thode efficace d'estimation du poids en pé diatrie, elle ne s'est pas montré e exacte et tend à sous-estimer le poids des enfants en Ontario. Tant que l'on n'aura pas dé veloppé d'outil de mesure plus pré cis pour les services d'urgence, les mé decins doivent ê tre conscients de cette divergence.

Use of the Broselow Tape in a Mexican Emergency Department

“…Despite periodic revisions to the tape based on updated census data, there is evidence that as obesity rates increase, the Broselow tape may increasingly underestimate weights (7,8). Conversely, malnutrition or endemic disease burdens in certain populations may result in overestimation of weight by using the Broselow tape.…”

The Accuracy of the Broselow™ Pediatric Emergency Tape for Weight Estimation in an Omani Paediatric Population

“…28,29 Conversely, studies from more economically developed countries have found that the BT tends to underestimate weight among paediatric populations. 5,15,25,31,32 These contradictory data may reflect the increasing prevalence of obesity in more developed countries. 15,16 The strengths of the current study include its large sample size and the collection of data from a tertiary care centre which receives referrals from all over the country.…”

“…5,15,25,31,32 These contradictory data may reflect the increasing prevalence of obesity in more developed countries. 15,16 The strengths of the current study include its large sample size and the collection of data from a tertiary care centre which receives referrals from all over the country. Therefore, the subjects included in this study may be considered representative of the general Omani paediatric population.…”

“…13,14 Although originally developed using data from a Western population, recent studies from the USA and Canada now indicate that the BT may significantly underestimate weight due to the rising prevalence of childhood obesity. 15,16 In addition, to the best of the authors' knowledge, no studies have yet been performed to assess the accuracy of the BT in estimating weight in an Omani paediatric population. Nevertheless, the BT is still used in Oman to gauge weight during paediatric emergencies.…”

An assessment of the accuracy of a novel weight estimation device for children

“…A study conducted in India revealed that the rate of accuracy within 10% of measured weight ranges from 33.5% to 52.6% 13. Additionally, some studies have demonstrated that the Broselow tape is not appropriate across different nations and races 1 9 22 28. In contrast, other studies have determined that the Broselow tape is acceptable when ethnicity is taken into account 24 25.…”