Does length-based resuscitation tape accurately place pediatric patients into appropriate color-coded zones?

To determine relationship between length-based resuscitation tape (LBT)-based color-coded zones and actual weight-based color-coded zones.

Data were retrospectively abstracted from 839 patients in Rochester, Minnesota, at birth, 4 to 6, and 10 to 12 years. Height was plotted on LBT to determine estimated weight and corresponding color zone. Patient's weight-based color zone was obtained by plotting measured weight on LBT. Degrees of discrepancy between length-based and actual weight-based color zones were assessed.

Total of 544, 520, and 143 subjects were analyzed at birth, 4 to 6, and 10 to 12 years, respectively, with a subset of 103 subjects measured longitudinally at more than 1 age strata. Among infants, all LBT color zones were the same as actual weight-based color zones. In children aged 4 to 6 years, 70% (n = 361) of LBT-estimated color zones were the same as actual weight-based color zones; LBT underestimated 19% (n = 99) by 1 color zone, 0.5% (n = 3) were underestimated by 2 color zones, 0.5% (n = 3) exceeded weight limit on LBT, and 10% (n = 54) were overestimated by 1 color zone. In adolescents aged 10 to 12 years, 40.6% (n = 58) of LBT-estimated color zones were the same as actual weight-based color zones; LBT underestimated 3.5% (n = 5) by 1 color zone, 44.1% (n = 63) exceeded weight limit on LBT, 11.2% (n = 16) were overestimated by 1 color zone, and 0.6% (n = 1) were overestimated by 2 color zones.

Overall, LBT reasonably estimates appropriate color zones for drug dosing. However, LBT tends to underestimate color zones among younger obese children and adolescents. Potential implications of the rising trend of overweight children on resuscitation practice and drug administration must be considered.