Related Experiment Videos
How good are doctors at estimating children's weight?
1Department of Accident and Emergency Medicine, King's College Hospital, London, United Kingdom.
Insights
Pediatric weight estimation in emergency departments is unreliable for accurate drug dosing. While average weight guesses are close, individual estimates vary widely, risking under- or over-prescribing critical medications.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Patient Safety
Background:
- Accurate drug dosing in children is crucial for effective treatment and preventing adverse events.
- Current practices in some pediatric emergency settings may not consistently involve precise weight measurements before prescribing medication.
Purpose of the Study:
- To evaluate the practice of weighing children before medication prescription in pediatric emergency departments.
- To assess the safety and accuracy of physicians estimating children's weights for drug prescribing.
Main Methods:
- A retrospective audit of 100 patient records was conducted to determine if children were weighed prior to drug prescription.
- Emergency department senior house officers estimated the weights of 75 children aged 12 years and under.
Main Results:
- Only 2% of children were weighed before medication was prescribed.
- The mean difference between actual and estimated weights was not statistically significant (-0.21, P=0.40).
- However, individual weight estimates showed a wide variation, with overestimations up to 300% and underestimations nearing 100%.
Conclusions:
- While group weight estimations may be close to actual weights, individual variations pose significant risks for accurate pediatric drug dosing.
- Reliance on weight estimation can lead to dangerous under- or over-prescription of analgesics, sedatives, and intravenous fluids.
- Accurate weight measurement is essential for safe prescribing, especially for medications requiring mg/kg dosing, though age-based prescribing may suffice for certain common drugs.
Objective:
(1) To see whether children are weighted before drugs are prescribed in an accident and emergency (A&E) department; (2) to assess how safe it is for doctors to guess children's weight if they prescribe "by eye".
Methods:
An audit of 100 sets of notes was performed to see if children were weighed before drugs were prescribed. A&E senior house officers were asked to estimate the weight of 75 children aged 12 years and under.
Results:
Children were weighed before prescribing in only two out of 100 cases. The mean difference between the actual and estimated weights was -0.21 (not significantly different from zero: P = 0.40); 95% of the estimates were within two standard deviations of the mean difference. The percentage difference between the actual and estimated weight varied between overestimates of 300% and underestimates of nearly 100%.
Conclusions:
The average guess of doctors as a group was approximately correct. However, there was a wide range of estimates for individuals. If the child's weight is guessed, the doctor could risk under- or overprescribing analgesia, sedation, or intravenous fluids. Given the wide range of estimates, actual weights are required for accurate prescribing. Prescribing on an age basis may be acceptable for drugs such as paracetamol or amoxycillin, but it is imperative to prescribe on a mg/kg basis for opiates, sedatives, and intravenous fluids because of the large variation in weight that can occur for a single age.