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How well does the Best Guess method predict children's weight in an emergency department in 2018-2019?
Daming Pan1, Mieke Foster2, Andrew Tagg3
1Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia.
Insights
The Best Guess weight prediction formulae remain accurate for children in emergencies. This study re-validated the formulae, finding their accuracy consistent with previous findings in Australian pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Biostatistics
- Health Informatics
Background:
- Accurate weight estimation is crucial for pediatric critical care interventions.
- Measuring weight in emergencies is often impractical.
- Age-based weight prediction formulae, like the Best Guess method, serve as vital alternatives.
Purpose of the Study:
- To re-validate the Best Guess weight prediction formulae in a contemporary Australian pediatric cohort.
- To compare the current predictive accuracy of the Best Guess formulae against a previous validation cohort from 2005.
- To assess the continued utility of age-based weight estimation in pediatric emergency settings.
Main Methods:
- A prospective observational study was conducted in a pediatric emergency department.
- Data from 961 children (1 month to 10 years) were collected between July 2018 and April 2019.
- Predictive performance of the Best Guess formulae was evaluated and compared to a 2005 cohort.
Main Results:
- The Best Guess formulae demonstrated a mean percent difference of -3.3%, generally over-estimating weight.
- Agreement within 10% was 41.8%, and within 20% was 72.6%.
- No significant difference in predictive accuracy was found between the current and the 2005 cohorts.
Conclusions:
- The Best Guess weight estimation method maintains its accuracy for use in pediatric emergency situations in this Australian cohort.
- The formulae show a slight tendency to over-estimate children's weight.
- Further research is recommended to evaluate accuracy across diverse ethnic subgroups.
Objective:
For seriously ill children, weight is often required to direct critical interventions. As it is not always feasible to measure weight in emergencies, age-based weight prediction formulae may be used as an alternative. The Best Guess formulae, derived in Australia, have been shown to be among the most accurate age-based methods in Australian children. They were validated in 2010. The present study aims to re-validate the Best Guess formulae and compare their performance to the previous validation cohort.
Methods:
A prospective observational study was conducted in the paediatric ED of a community teaching hospital. It included a convenience sample of children aged 1 month to 10 years who presented between July 2018 and April 2019. Seriously ill children were excluded. Data collected included measured weight, height, gender, age and ethnic group. The outcomes of interest were predictive performance of Best Guess formulae and comparison of predictive accuracy with a 2005 cohort from the same ED.
Results:
A total of 961 patients were included; 42% girls, median age 3 years. The sample was ethnically diverse. Mean percent difference in weight was -3.3% with the formulae usually over-estimating weight. Overall, agreement within 10% was 41.8%; agreement within 20% was 72.6%. Predictive accuracy was not significantly different between the cohorts.
Conclusion:
The Best Guess method has not reduced in accuracy as a weight estimation method in emergent situations in this Australian cohort, despite a tendency to slightly over-estimate children's weight. Further study is needed to test the Best Guess method's accuracy in ethnic subgroups.
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