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2 results

  • Weight Estimation for Drug Dose Calculations in the Prehospital Setting – A Systematic Review

  • Mike Wells, Brendon Henry, Lara Goldstein
  • Journal:
    Prehospital and Disaster Medicine / Volume 38 / Issue 4 / August 2023
    Published online by Cambridge University Press:
    13 July 2023, pp. 471-484
    Print publication:
    August 2023
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  • Background:

    Weight estimation is required to enable dose calculations for weight-based drugs administered during emergency care. The accuracy of the estimation will determine the accuracy of the administered dose. This is an important matter of patient safety. The objective of this systematic review was to collect, review, evaluate, and create a synthesis of the current literature focusing on the accuracy of weight estimation in the prehospital environment.

    Methods:

    This systematic review followed the PRISMA guidelines. Studies were identified and included if they were peer reviewed, full length, published in English, and contained original data. Studies utilizing any form of weight estimation methodology in the prehospital setting (in children or adults) were included. Data on the quality of the studies and accuracy of the weight estimation systems were extracted. Common themes were also identified.

    Results:

    Twenty-five studies met the inclusion criteria, with only nine studies (36.0%) containing useful weight estimation accuracy data. The overall quality of the studies was poor. The Broselow tape and paramedic estimates were the most studied methods of weight estimation, but there was insufficient evidence to support conclusions about accuracy. The major themes identified included the importance of accurate weight estimation and drug dosing as critical matters of patient safety, and the need for training to ensure these processes are performed accurately.

    Conclusions:

    There were limited robust data identified on the accuracy of different weight estimation methods used in the prehospital setting. Future high-quality clinical research in this area is of critical importance to ensure patient safety in the prehospital environment.

  • LO081: Novel EMS spine board to accurately weigh critically ill or injured children

  • S.E. Milne, A.G. Crocco, C.R. Carpenter, K. Milne
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
    Published online by Cambridge University Press:
    02 June 2016, p. S58
    Print publication:
    May 2016
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  • Introduction: A rapid and accurate weight of a child can be of critical importance during pediatric emergencies. The Broselow Tape (BT) is the gold standard for estimating a child’s weight based on their length. It separates children into incremental weight categories. Studies have shown that the BT is not accurate. We created a new pediatric spine board (PedEBoard) that weighs the child. The objective of this study was to compare the agreement between the actual weight vs. the PedEBoard weight and BT estimated weight of children presenting to a pediatric emergency department (ED). Methods: Ethics approval was obtained from McMaster University. A power calculation was done for sample size to detect 10% error. Consecutive children were recruited who presented to McMaster University’s Children’s ED on two days in March 2015. Children were excluded if their length was outside the BT range, non-English speaking or critically ill. Children had their weight taken by the triage nurse either on an infant scale or on a traditional standing scale. The nurse also took the child’s length using a standard measuring tape or height on the standing medical scale. Infants were placed on the PedEBoard by investigators while older children were asked to lie down on the board. Investigators were blinded to the actual weight. BT weight was determined by the palmPEDi Lite app. Bland-Altman analysis was performed, comparing the percent difference between the actual weight vs. PedEBoard weight and actual weight vs. BT weight. The correlation between the PedEBoard and BT was assessed using the Spearman coefficient of rank. Data was entered into MedCalc for Windows 98, Version 15.2.2 Results: A total of 157 children were included in the study. The mean actual weight was 19.4kg (95% CI 17.4 to 21.3) vs. the PedEBoard weight 19.4kg (95% CI 17.4 to 21.3) vs. the BT weight 16.9kg (95% CI 15.6 to 18.2). Bland-Altman percent difference was 0.1% (95% CI -2.0 to 1.8%) between the actual weight and the PedEBoard weight and 9.6% (95% CI -22.0% to 41.2%) between the actual weight and the BT weight. The Spearman coefficient of rank correlation was 1.000 p<0.0001 (95% CI 0.999 to 1.000) for the PedEBoard and 0.969 p<0.001 (95% CI 0.957 to 0.977) for the BT. The BT provided the wrong weight category 80% of the time vs. 8% for the PedEBoard. Conclusion: The PedEBoard closely agreed with the actual weight of the child while the Broselow Tape estimate often did not.