Size does matter – Age-related weight estimation in “tall n’ thin” and “tiny n’ thick” children and a new habitus-adapted alternative to the EPLS-formula

Erker, Christian G.; Santamaria, Mario; Moellmann, Michael

doi:10.1016/j.resuscitation.2014.04.032

Cited by 14 publications

(9 citation statements)

References 29 publications

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“…Limitations: Limited and incomplete data presentation. Erker 2014 [ 147 ] N/A WHO/CDC reference centiles R 1 to 12 years EPLS, APLS, Luscombe, BG, Park, Shann, Nelson, novel habitus-modified formulas None 1 High Findings: Potentially enhanced accuracy of age-based equations by using a habitus-specific formula, if length-based methods not available. Comments: Three formulas for “thick”, “normal” and “thin” children.…”

Section: Resultsmentioning

confidence: 99%

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

2017

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

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Section: Resultsmentioning

confidence: 99%

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

2017

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“…No age formula has ever been shown to perform satisfactorily well in any previous study (best performances: PW10 45% to 55%) [2]. The new Erker formula, which is habitus-modified, failed to deliver on the potential showed in its theoretical development [16]. This error was predominantly one of modest overestimation of weight in children with normal habitus and modest underestimation of weight in fat children.…”

Section: Age-based Formulas Failed Badly Because Of Large Variabilitymentioning

confidence: 90%

“…TBW was estimated with the Broselow tape [14] and PAWPER XL tape [8] as well as the Mercy Method [15], the Advanced Paediatric Life Support (APLS) formulas, Erker formulas [16], the European Paediatric Life Support (EPLS) formula, and the Best Guess formulas ( Table 1). A visual gestalt assessment of habitus was used to classify children for the Erker formulas into "thin," "normal," and "thick" categories [16]. Body mass index (BMI), BMI-for-age Z-scores, and an estimate of IBW (using the BMI50 method) were calculated using the Centers for Disease Control (CDC) growth charts [17].…”

Section: Methodsmentioning

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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“…Even updated tools such as the ‘updated APLS’ from the fifth edition handbook have been shown to perform worse than the original tool in Filipino children 1213 The Broselow tape is the standard length-based tool and performs better than age-based methods; however, there are concerns that this method may still be inaccurate and that other methods based on body habitus or mid-arm circumference may be more accurate 811 14…”

Section: Introductionmentioning

confidence: 99%

Estimating the weight of ethnically diverse children attending an Australian emergency department: a prospective, blinded, comparison of age-based and length-based tools including Mercy, PAWPER and Broselow

et al. 2016

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ObjectiveTo prospectively compare the actual weights of Australian children in an ethnically diverse metropolitan setting with the predicted weights using the Paediatric Advanced Weight Prediction in the Emergency Room (PAWPER) tape, Broselow tape, Mercy system and calculated weights using the updated Advanced Paediatric Life Support (APLS), Luscombe and Owens and Best Guess formulae.MethodsA prospective, cross-sectional, observational, blinded, convenience study conducted at the Children's Hospital at Westmead Paediatric Emergency Department in Sydney, Australia. Comparisons were made using Bland-Altman plots, mean difference, limits of agreement and estimated weight within 10% and 20% of actual weight.Results199 patients were enrolled in the study with a mean actual weight of 27.2 kg (SD 17.2). Length-based tools, with or without body habitus adjustment, performed better than age-based formulae. When measuring estimated weight within 10% of actual weight, PAWPER performed best with 73%, followed by Mercy (69%), PAWPER with no adjustment (62%), Broselow (60%), Best Guess (47%), Luscombe and Owens (41%) and revised APLS (40%). Mean difference was similar across all methods ranging from 0.4 kg (0.0, 0.9) for Mercy to −2.2 kg (−3.5, −0.9) for revised APLS. Limits of agreement were narrower for the length-based tools (−5.9, 6.8 Mercy; −8.3, 5.6 Broselow; −9.0, 7.1 PAWPER adjusted; −12.1, 9.2 PAWPER unadjusted) than the age-based formulae (−18.6, 17.4 Best Guess; −19.4, 15.1 revised APLS, −21.8, 17.7 Luscombe and Owens).ConclusionIn an ethnically diverse population, length-based methods with or without body habitus modification are superior to age-based methods for predicting actual body weight. Body habitus modifications increase the accuracy and precision slightly.

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Size does matter – Age-related weight estimation in “tall n’ thin” and “tiny n’ thick” children and a new habitus-adapted alternative to the EPLS-formula

Cited by 14 publications

References 29 publications

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

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

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

Estimating the weight of ethnically diverse children attending an Australian emergency department: a prospective, blinded, comparison of age-based and length-based tools including Mercy, PAWPER and Broselow

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