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Updated: Jun 26, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Comparing the performance of pediatric weight estimation methods
Andrew Shieh1, Alexander J Rogers2, Chiu-Mei Chen1
1Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States of America.
Insights
The Broselow tape is the most accurate method for estimating pediatric weight, especially for children with medical complexity. The Antevy formula is the best age-based option for weight estimation in children.
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.
Background:
Weight estimation is essential in the care of ill children when a weight cannot be obtained. This is particularly important for children with medical complexity, who are at higher risk for adverse drug events. Our objective was to compare the accuracy of different methods of weight estimation in children and stratify by the presence of medical complexity.
Methods:
We performed a retrospective cross-sectional study of children (<18 years) seen in the emergency department (ED) or ambulatory clinic from January 1, 2013 to December 31, 2022 at a tertiary academic pediatric center. We compared the performance of nine age-based formulae and two length-based methods using metrics of mean average error (MAE), root mean square error (RMSE), and agreement within 10% and 20% of measured weight. We additionally evaluated the approaches stratified by body mass index (BMI) and the presence of medical complexity.
Results:
Of 361,755 children (median age 8.2 years, IQR 2.5-14.2 years; 51.5% male), 59,283 (16.4%) were seen in the ED. Length was measured or available in 21,330 (36.0%) patients in the ED and 293,410 (97%) patients in clinics. The Broselow tape outperformed all methods, with 50.7% estimates within 10% of measured weight, 80.0% estimates within 20% of measured weight, the lowest MAE (2.5 kg), and lowest RMSE (4.5 kg). The Antevy formula was the most accurate age-based formula, with 49.2% estimates within 10% of measured weight, 80.1% estimates within 20% of measured weight, MAE of 2.8 kg, and RMSE of 4.7 kg. Estimates became less accurate as BMI and estimated weight increased for all methods. Among children with medical complexity (14.1%), the Broselow tape consistently outperformed age-based formulae, with 47.7% estimates within 10% of measured weight, 77.1% estimates within 20% of measured weight, MAE of 2.6 kg, and RMSE of 5.4 kg. The Antevy formula remained the most accurate age-based method among children with medical complexity.
Conclusion:
The Broselow tape predicted weight most accurately in this large sample of children, including among those with medical complexity. The Antevy formula is the most accurate age-based method for pediatric weight estimation.
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