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Comparative Performance of Pediatric Weight Estimation Techniques: A Human Factor Errors Analysis
Susan M Abdel-Rahman1, Ryan Jacobsen, Jennifer L Watts
1From the *Division of Clinical Pharmacology, Children's Mercy Hospital; †Department of Pediatrics, University of Missouri-Kansas City, School of Medicine; ‡Division of Emergency Medicine, Children's Mercy Hospital; §Department of Emergency Medicine, Truman Medical Center; and ∥Department of Nursing, Children's Mercy Hospital, Kansas City, MO.
Insights
Accurate pediatric weight estimation is crucial in emergencies. No single method proved perfect, with human factors errors impacting all techniques, highlighting the need for improved training and tool development in emergency care settings.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Medical Device Technology
Background:
- Accurate weight estimation in children is critical for appropriate medication dosing and treatment in emergency settings.
- Existing weight estimation methods vary in accuracy and are susceptible to human error.
- Understanding performance characteristics and error types is essential for improving pediatric emergency care.
Purpose of the Study:
- To compare the performance of seven different pediatric weight estimation methods.
- To evaluate predictive accuracy and identify human factors errors associated with each method.
- To inform the selection and refinement of weight estimation strategies in pediatric emergency care.
Main Methods:
- A prospective study involving 80 emergency care providers (raters) and 80 children (2 months to 16 years).
- Raters used seven strategies: visual estimation, Advanced Pediatric Life Support, Luscombe and Owens, Broselow tape, devised weight estimation method, 2D Mercy TAPE (2DT), and 3D Mercy TAPE (3DT).
- Quantitative errors were assessed by comparing rater estimates to optimal method application results.
Main Results:
- All methods showed less accuracy than optimal application, with skill-based, perception, and judgment errors observed.
- The Broselow tape had limited eligibility (63%) but was used in 96% of cases.
- Specific errors included underestimation by visual estimation, order-of-operation mistakes in calculations, misclassification of weight categories, and incorrect device usage (2DT).
Conclusions:
- Human factors errors (skill-based, perception, judgment) occurred in over 5% of estimations.
- No single weight estimation strategy achieved 100% accuracy.
- Improvements in training and tool design are needed to enhance the reliability of pediatric weight estimation in emergency care.
Objective:
We compared performance characteristics of 7 weight estimation methods examining predictive performance and human factors errors.
Methods:
This was a prospective study of 80 emergency care providers (raters) and 80 children aged 2 months to 16 years. Raters estimated weights in 5 children with the following 7 strategies: visual estimation, Advanced Pediatric Life Support, Luscombe and Owens, Broselow tape, devised weight estimation method, 2D Mercy TAPE (2DT), and 3D Mercy TAPE (3DT). Quantitative errors were determined by checking rater values against values returned with optimal method use.
Results:
Four hundred rater-child pairings generated 2800 weight estimates. For all methods, rater-estimated weights were less accurate than weights derived by optimal application. Skill-based, perception, and judgment/decision error were observed. For visual estimation, weights were underestimated in most children. For Advanced Pediatric Life Support/Luscombe and Owens, order of operations markedly impacted errors with 23% of calculations requiring addition first performed incorrectly versus 9% of calculations requiring multiplication first. For Broselow tape, only 63% of cases were eligible for estimation with this device, yet raters assigned a weight in 96% of cases. For Devised Weight Estimation Method, 96% of overweight and 48% of obese children were classified as slim or average. For 2DT/3DT, the 2DT was prone to more errors most commonly use of the wrong side of the device (24%). The impact of rater characteristics on error was most pronounced for methods requiring calculation.
Conclusions:
Skill-based, perception, or judgment errors were observed in more than 1 of 20 cases. No singular strategy was used with 100% accuracy.
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