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Internationalizing the Broselow tape: how reliable is weight estimation in Indian children
Naresh Ramarajan1, Rajesh Krishnamoorthi, Matthew Strehlow
1Stanford University School of Medicine, Stanford, CA, USA. nareshr@stanford.edu
Insights
The Broselow tape overestimates weight in Indian children over 10 kg, increasing medical error risks. A 10% weight-correction factor may improve accuracy for pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Measurement Accuracy
- Medical Device Evaluation
Background:
- The Broselow pediatric emergency weight estimation tape uses height-weight correlations for standardized dosing and equipment selection.
- Accurate weight estimation is critical in pediatric emergencies to prevent medication errors and ensure appropriate equipment size.
Purpose of the Study:
- To evaluate the accuracy of the Broselow tape in estimating the weight of the Indian pediatric population.
- To assess the Broselow tape's performance across different pediatric weight categories.
Main Methods:
- A prospective cross-sectional study involving 548 children in Chennai, India.
- Comparison of measured weights against Broselow-predicted weights across three weight groups (<10 kg, 10-18 kg, >18 kg).
- Analysis of Broselow color-coded zone agreement and percentage difference within 10% of measured weight.
Main Results:
- The Broselow tape showed significant overestimation in children weighing over 10 kg (mean differences of -11.3% and -12.9%).
- Color-coded zone agreement decreased with higher weight categories (70.8% for <10 kg to 37.5% for >18 kg).
- Agreement within 10% also reduced significantly in heavier children (52.6% for <10 kg to 33.5% for >18 kg).
Conclusions:
- The Broselow tape demonstrates reduced accuracy and overestimates weight in Indian children over 10 kg.
- Overestimation poses a risk for incorrect medication dosages and equipment selection in pediatric emergencies.
- A 10% weight-correction factor is suggested to improve the Broselow tape's accuracy in this population.
Objectives:
The Broselow pediatric emergency weight estimation tape is an accurate method of estimating children's weights based on height-weight correlations and determining standardized medication dosages and equipment sizes using color-coded zones. The study objective was to determine the accuracy of the Broselow tape in the Indian pediatric population.
Methods:
The authors conducted a 6-week prospective cross-sectional study of 548 children at a government pediatric hospital in Chennai, India, in three weight-based groups: < 10 kg (n = 175), 10-18 kg (n = 197), and > 18 kg (n = 176). Measured weight was compared to Broselow-predicted weight, and the percentage difference was calculated. Accuracy was defined as agreement on Broselow color-coded zones, as well as agreement within 10% between the measured and Broselow-predicted weights. A cross-validated correction factor was also derived.
Results:
The mean percentage differences were -2.4, -11.3, and -12.9% for each weight-based group. The Broselow color-coded zone agreement was 70.8% in children weighing less than 10 kg, but only 56.3% in the 10- to 18-kg group and 37.5% in the > 18-kg group. Agreement within 10% was 52.6% for the < 10-kg group, but only 44.7% for the 10- to 18-kg group and 33.5% for the > 18-kg group. Application of a 10% weight-correction factor improved the percentages to 77.1% for the 10- to 18-kg group and 63.0% for the >18-kg group.
Conclusions:
The Broselow tape overestimates weight by more than 10% in Indian children > 10 kg. Weight overestimation increases the risk of medical errors due to incorrect dosing or equipment selection. Applying a 10% weight-correction factor may be advisable.
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