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Effect of Body Mass Index Category on Body Surface Area Calculation in Children Undergoing Cardiac Procedures
Olubukola O Nafiu1, Kwaku Owusu-Bediako, S Devi Chiravuri
1From the Section of Pediatric Anesthesiology, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Insights
Pediatric body surface area (BSA) formulas overestimate values in overweight and obese children. Accurate BSA determination is crucial for appropriate medical interventions in pediatric cardiac procedures.
Area of Science:
- Pediatric cardiology
- Medical biometry
- Anthropometry
Background:
- Existing body surface area (BSA) formulas may not accurately reflect measurements in pediatric populations, particularly with rising childhood obesity rates.
- Many established BSA equations were developed prior to the widespread prevalence of childhood obesity and included limited pediatric data.
- There is a need to assess the performance of current BSA formulas in overweight and obese children.
Purpose of the Study:
- To compare the performance of six common body surface area (BSA) formulas in children.
- To evaluate how body mass index (BMI) categories affect the accuracy of these BSA formulas.
- To assess BSA formula performance in children undergoing elective cardiac procedures.
Main Methods:
- Six pediatric BSA formulas were selected from existing literature.
- Measured height and weight were used to calculate BSA for 1000 pediatric subjects.
- Statistical analyses, including ANOVA and Bland-Altman analysis, compared formula-derived BSA values against a reference standard across BMI categories.
Main Results:
- All six BSA formulas demonstrated strong positive correlations with each other and the reference standard (0.99-1.00).
- Calculated BSA values were significantly higher in overweight and obese children compared to normal-weight children across all age groups.
- Formula performance varied across different BMI categories.
Conclusions:
- Obesity significantly impacts body surface area (BSA) calculations in children undergoing cardiac procedures.
- Current BSA formulas may lead to inaccuracies in therapeutic interventions for overweight and obese children.
- Further research is needed to develop and validate BSA formulas that accurately represent diverse pediatric populations, including those with obesity.
Background:
Many of the common equations used for body surface area determination were either introduced before the widespread prevalence of childhood obesity, contained very few children in their sample, or have not been assessed in overweight/obese children. Therefore, we compared 6 body surface area formulae to determine their performance across body mass index categories using cross-sectional anthropometric data of children who underwent elective cardiac procedures.
Methods:
We selected 6 formulae from the literature that included data from pediatric subjects in their derivation. We then substituted measured height and weight into each equation to compute body surface area data for the study subjects. The average values of the 6 formulae were calculated for each patient and used as reference for comparison. Comparisons between each formula and the reference standard were made with the 1-way ANOVA, Pearson correlation coefficient (measure of precision), the Lin concordance correlation coefficient (measure of bias and precision), and the Bland-Altman limit-of-agreement. All comparisons were made across age, sex, and body mass index categories.
Results:
Among the 1000 (mostly Caucasian: 76.1%) subjects, 16.7% were overweight, while 14.1% were obese and 51.2% were girls. All calculated body surface area data showed a strong positive correlation with each other and the derived reference body surface area values (0.99-1.00; P < .001). Calculated body surface area values for all the formulae were significantly higher in overweight and obese children across every age group.
Conclusions:
Obesity status is a critical factor in the determination of body surface area values in children undergoing elective cardiac procedures. We caution that indexed hemodynamic and other therapeutic interventions may be inappropriate if limitations of body surface area formulae and the effect of obesity are not taken into consideration when caring for overweight and obese children. Body surface area studies utilizing accurate contemporary techniques that include sufficient number of overweight and obese children of various races are urgently needed.
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