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Updated: Sep 20, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Addition of Midthigh Circumference Improves Predictive Ability of Broselow Tape Weight Estimation
Wajeeha Saeed1, Amber Akbar2, Muhammad Waseem3
1From the Department of Pediatric Emergency Medicine, Medical College of Georgia, Augusta University.
Insights
Adding midthigh circumference (MTC) to the Broselow tape (BT) significantly improves pediatric weight prediction accuracy, especially for children over two years old. The Centers for Disease Control and Prevention (CDC)-defined MTC method showed slightly better results than visual approximation.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Assessment Tools
- Biometrics
Background:
- Accurate weight estimation is critical for pediatric emergency care.
- The Broselow tape (BT) is a widely used tool for estimating pediatric weight and guiding medication and equipment selection.
- Limitations exist in the Broselow tape's weight prediction accuracy.
Purpose of the Study:
- To enhance the accuracy of Broselow tape (BT) weight prediction by incorporating midthigh circumference (MTC) measurements.
- To compare and standardize different methods for measuring MTC in pediatric patients.
- To evaluate the performance of combined BT and MTC models versus the BT-only model.
Main Methods:
- A prospective, observational study was conducted in a pediatric emergency department.
- Included were children up to 12 years of age, excluding those whose management would be interfered with.
- Data collected included midthigh circumference (MTC) using two methods (visual approximation and CDC-defined), height, BT weight, and actual weight.
Main Results:
- Both MTC-inclusive models demonstrated significantly improved weight prediction compared to the BT-only model (adjusted R2: 0.921-0.928 vs 0.843; RMSE: 2.56-2.70 vs 3.80).
- The MTC plus BT models showed even greater improvement in children older than 2 years (adjusted R2: 0.859-0.872 vs 0.616; RMSE: 3.03-3.18 vs 5.27).
- The Centers for Disease Control and Prevention (CDC)-defined MTC method yielded slightly better weight prediction than visual approximation.
Conclusions:
- Incorporating midthigh circumference (MTC) measurements with the Broselow tape (BT) significantly improves weight prediction accuracy in children.
- This enhanced accuracy is particularly notable in children over two years of age.
- The CDC-defined MTC measurement method is a slightly more accurate predictor of actual weight compared to visual approximation.
Objectives:
This study aimed to improve the accuracy of Broselow tape (BT) weight prediction by adding midthigh circumference (MTC) and to compare and standardize the methods for measuring MTC.
Methods:
This prospective, observational study was conducted in a pediatric emergency department of a tertiary care children's hospital. Children up to 12 years of age presenting to emergency department were included. Children were excluded if obtaining the data would interfere with their acute management. The data collected included MTC, height, BT weight, and actual weight. Three models were built. Broselow tape-only model and MTC plus BT model used 2 methods for MTC measurements: visual approximation of thigh midpoint (visual MTC1) and Centers for Disease Control and Prevention (CDC)-defined method (CDC MTC2).
Results:
A total of 430 children were enrolled during pre-coronavirus disease era. Of these, 234 were boys (54.4%) and 196 (45.6%) were girls. Data were categorized into children younger than 2 years (224 [52.1%]) and older than 2 years (206 [47.9%]). African American constituted 250 (58%); White, 136 (31%); and unspecified, 27 (6%). For the entire cohort, both models that included MTC were significantly better at weight prediction with larger adjusted R2 (visual MTC1, 0.921; CDC MTC2, 0.928) and smaller root mean squared (RMSE) (visual MTC1, 2.70; CDC MTC2, 2.56) compared with BT-only model (adjusted R2 = 0.843; RMSE, 3.80). Midthigh circumference plus BT models performed even better in children older than 2 years compared with BT-only model with adjusted R2 (visual MTC1, 0.859; CDC MTC2, 0.872 vs 0.616) and RMSE (visual MTC1, 3.18; CDC MTC2, 3.03 vs 5.27).
Conclusions:
The inclusion of MTC with BT resulted in a more accurate weight prediction in children especially greater than 2 years old. Midthigh circumference model using CDC-defined method was slightly better predictor of actual weight than visual approximation.
