Comment on "Pediatric emergency backpacks-effects of using xABCDE- and Broselow-systems on pediatric emergency care"

This letter to the editor critiques the recent study by Brune et al. (2025) comparing xABCDE and Broselow pediatric emergency backpacks. While appreciating the investigation, we raise two significant methodological concerns that limit the applicability of the study's conclusions. First, the implementation of the Broselow system was incomplete, as it lacked integrated medications, necessitating the use of a separate adult medication kit. This design fails to replicate the clinical reality of managing a single, self-contained system and introduces unmeasured variables like cognitive load and workflow interference, potentially invalidating the reported efficiency metrics. Second, and more critically, the study measured only preparation speed while completely overlooking the Broselow system's primary safety function: the prevention of medication dosing errors. By not analyzing dosing accuracy, the study neglects the most clinically important outcome in pediatric resuscitation, where weight estimation inaccuracies can lead to dangerous ten-fold errors. These limitations preclude a valid assessment of the Broselow system's true comparative value. Future research must evaluate fully-equipped, self-contained systems, and incorporate medication safety outcomes to determine the optimal approach for pediatric emergency care.Conclusion and Trial registration: These limitations preclude a valid assessment of the Broselow system's true comparative value. Future research must evaluate fully-equipped, self-contained systems and incorporate medication safety outcomes to determine the optimal approach for pediatric emergency care.