Errors in weight estimation in the emergency department: comparing performance by providers and patients

To examine biases in weight estimation by Emergency Department (ED) providers and patients, a convenience sample of ED providers (faculty, residents, interns, nurses, medical students, paramedics) and patients was studied. Providers (n = 33), blinded to study hypothesis and patient data, estimated their own weight as well as the weight of 11-20 patients each. An independent sample of patients (n = 95) was used to assess biases in patients' estimation of their own weight. Data are represented as over, under, or within +/- 5 kg, the dose tolerance standard for thrombolytics. Logistic regression analysis revealed that patients are almost nine times more likely to accurately estimate their own weight than providers; yet 22% of patients were unable to estimate their own weight within 5 kg. Of all providers, paramedics were significantly worse estimators of patient weight than other providers. Providers were no better at guessing their own weight than were patients. Though there was no systematic estimate bias by weight, experience level (except paramedic), or gender for providers, those providers under 30 years of age were significantly better estimators of patient weight than older providers. Although patient gender did not create a bias in provider estimation accuracy, providers were more likely to underestimate women's weights than men's. In conclusion, patient self-estimates of weight are significantly better than estimates by providers. Inaccurate estimates by both groups could potentially contribute to medication dosing errors in the ED.