Comparing the performance of pediatric weight estimation methods

Area of Science:

• Pediatric medicine
• Clinical pharmacology
• Biostatistics

Background:

• Accurate weight estimation is critical for pediatric patient care, particularly for children with medical complexity who face higher risks of adverse drug events.
• Reliable weight data is essential when direct measurement is not feasible, impacting treatment efficacy and safety.

Purpose of the Study:

• To compare the accuracy of various weight estimation methods in children.
• To evaluate these methods stratified by the presence of medical complexity and body mass index (BMI).

Main Methods:

• A retrospective cross-sectional study analyzed data from 361,755 children (<18 years) in emergency departments and clinics from 2013-2022.
• Nine age-based formulas and two length-based methods were compared using mean average error (MAE), root mean square error (RMSE), and agreement within 10% and 20% of measured weight.
• Analyses were stratified by BMI and medical complexity.

Main Results:

• The Broselow tape demonstrated superior accuracy, achieving 50.7% estimates within 10% of measured weight and the lowest MAE (2.5 kg) and RMSE (4.5 kg).
• The Antevy formula was the most accurate age-based method (49.2% within 10%, MAE 2.8 kg, RMSE 4.7 kg).
• Accuracy decreased with increasing BMI and estimated weight; the Broselow tape remained most accurate for children with medical complexity.

Conclusions:

• The Broselow tape is the most accurate method for pediatric weight estimation in a large, diverse patient population, including those with medical complexity.
• The Antevy formula stands out as the most accurate age-based approach for estimating children's weight.