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Estimating children's weight in a Rwandan emergency centre
Appolinaire Manirafasha1, Sojung Yi1, Giles N Cattermole1,2
1Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.
Insights
Accurate pediatric weight estimation is crucial for treatment. The 1998 Broselow Tape is recommended for children aged 1-10 in Rwanda, outperforming age-based formulas.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Biostatistics
Background:
- Accurate pediatric weight estimation is vital for drug dosages, fluid administration, and ventilator settings.
- Weight measurement is often impractical in emergency situations.
- Existing estimation methods, primarily age or height-based, vary in accuracy.
Purpose of the Study:
- To compare the accuracy of various pediatric weight estimation methods in Rwanda.
- To develop a new, localized age-based weight estimation tool for Rwandan children.
Main Methods:
- Retrospective study of 327 Rwandan children (1-10 years) at Centre Hospitalier Universitaire de Kigali.
- Weight estimation using four Broselow Tape versions and age-based formulas.
- Development of the 'Rwanda Rule' formula and comparison via Bland-Altman analysis.
Main Results:
- The derived 'Rwanda Rule' (weight = [1.7 × age] + 8) and the Advanced Paediatric Life Support formula showed similar accuracy.
- Both formulas were more accurate than other age-based methods (69% within 20% of actual weight).
- The 1998 Broselow Tape demonstrated the highest accuracy (84.8% within 20% of actual weight).
Conclusions:
- This study provides the first comparison of pediatric weight estimation methods in Rwanda.
- The 1998 Broselow Tape is recommended for children aged 1-10 years in this setting.
- The Advanced Paediatric Life Support formula is a viable alternative if the Broselow Tape is unavailable.
Introduction:
Most drugs, fluids and ventilator settings depend on the weight of a paediatric patient. However, knowledge of the weight is often unavailable as the urgency of the situation may impede measurement. The most common methods for paediatric weight estimation are based on height or age. This study aimed to compare the accuracy of various weight estimation methods and to derive a dedicated age-based tool within a Rwandan setting.
Methods:
This was a retrospective study using age, weight and height data from randomly selected charts of Rwandan children, aged between one and ten years, who attended the paediatric emergency centre, Centre Hospitalier Universitaire de Kigali, Rwanda. Weights were estimated using four versions of the Broselow Tape and several age-based formulae. Linear regression was used to derive a new age-based weight estimation formula, the Rwanda Rule. Weight estimations were then compared with actual weight using Bland-Altman analysis, and the proportions of estimates within 10 and 20% of actual weight.
Results:
There were 327 children included in the study. The derived Rwanda Rule was: weight (kg) = [1.7 × age (years)] + 8. This formula and the original Advanced Paediatric Life Support formula (weight = [2 × age] + 8) performed similarly. Both were better than other age-based formulae (69% of estimates within 20% of actual weight). All editions of the Broselow Tape performed better than age-based rules. The 1998 version performed best with 84.8% of estimates within 20% of actual weight.
Discussion:
This study is the first to compare paediatric weight estimation methods in Rwanda. Locally, and until we have evidence from further research that other methods are superior, we would advise use of the 1998 Broselow Tape in children aged one to ten years old. Where the Broselow Tape is not available, the original Advanced Paediatric Life Support formula should be used.