"Weighing Cam": A New Mobile Application for Weight Estimation in Pediatric Resuscitation

Weight Estimation for Drug Dose Calculations in the Prehospital Setting - A Systematic Review

BACKGROUND

Weight estimation is required to enable dose calculations for weight-based drugs administered during emergency care. The accuracy of the estimation will determine the accuracy of the administered dose. This is an important matter of patient safety. The objective of this systematic review was to collect, review, evaluate, and create a synthesis of the current literature focusing on the accuracy of weight estimation in the prehospital environment.

METHODS

This systematic review followed the PRISMA guidelines. Studies were identified and included if they were peer reviewed, full length, published in English, and contained original data. Studies utilizing any form of weight estimation methodology in the prehospital setting (in children or adults) were included. Data on the quality of the studies and accuracy of the weight estimation systems were extracted. Common themes were also identified.

RESULTS

Twenty-five studies met the inclusion criteria, with only nine studies (36.0%) containing useful weight estimation accuracy data. The overall quality of the studies was poor. The Broselow tape and paramedic estimates were the most studied methods of weight estimation, but there was insufficient evidence to support conclusions about accuracy. The major themes identified included the importance of accurate weight estimation and drug dosing as critical matters of patient safety, and the need for training to ensure these processes are performed accurately.

CONCLUSIONS

There were limited robust data identified on the accuracy of different weight estimation methods used in the prehospital setting. Future high-quality clinical research in this area is of critical importance to ensure patient safety in the prehospital environment.

A validation of newly developed weight estimating tape for Korean pediatric patients

Pediatric drug dosages are based on body weight, so accurate measurement thereof is essential. However, this is not possible in emergencies. When using weight-estimating tapes, World Health Organization (WHO) growth charts serve as reference weights; however, local growth charts might be more accurate. This study developed a tape based on 2017 Korean National Growth Charts, which are more suitable for the Korean population than WHO growth charts, and evaluated its performance in a Korean pediatric population. This prospective cross-sectional study analyzed 792 pediatric patients who had visited the emergency department from June 2021 to December 2021. Weights were estimated using the Broselow tape (BT), Pediatric Advanced Weight Prediction in the Emergency Room XL (PAWPER XL), and Body Habitus-based Pediatric Emergency Tape (BHPET). The performance and measurement agreement of the tapes were analyzed. Among the tapes, the BHPET had the smallest mean absolute percentage error (MAPE), of 10.23%, and a root mean square percentage error (RMSPE) of 14.14%. Also, the percentage of weight estimations within 10% of the actual weight (PW10) was 59.6%, indicating better accuracy than the BT and PAWPER XL in all age groups. The intraclass correlation coefficients of the BT, PAWPER XL, and BHPET were 0.931, 0.977, and 0.985, respectively (p < 0.001). The performance and accuracy of the BHPET was similar or slightly superior to that of the other tapes. The body weight estimated using the BHPET for a local pediatric population was sufficiently correlated with the actual body weight.

AiRDose: Developing and Validating an Augmented Reality Smartphone Application for Weight Estimation and Dosing in Children

OBJECTIVES

Inaccurate weight estimation is a contributing factor to medical error in pediatric emergencies, especially in the prehospital setting. Current American Heart Association guidelines recommend the use of length-based weight estimation tools such as the Broselow tape. We developed the AiRDose smartphone application that uses augmented reality to provide length-based weight estimates, as well as medication dosing, defibrillation energy, and equipment sizing recommendations; AiRDose was programmed to use Broselow conversions to obtain these estimates. The primary objective was to compare the length estimated by AiRDose with the actual length obtained by the standard tape measure. The secondary objectives were to compare the estimated weights and critical medication doses from AiRDose with current established methods.

METHODS

In this prospective validation study, lengths and estimated weights were obtained for children presenting to 2 emergency departments using AiRDose, Broselow, and a standard tape measure; actual weight was recorded from the patient chart. Using the AiRDose estimated weights, hypothetical doses of epinephrine and lorazepam were calculated and compared with doses recommended via Broselow and to actual weight-based doses. Spearman rank correlation coefficients were calculated. We defined an acceptable difference of 20% between AiRDose and standard measurements as clinically relevant.

RESULTS

Five hundred forty-nine children (mean age, 4.8 years; standard deviation [SD], 2.9 years) were recruited. There were 99.6% of AiRDose lengths within a 20% difference of tape-measure lengths. There was a significant correlation between AiRDose and tape-measure length measurements (r = 0.989, P < 0.0001), and between AiRDose and Broselow weights (r = 0.983, P < 0.0001) and AiRDose and actual weights (r = 0.886, P < 0.0001). AiRDose lorazepam and epinephrine doses correlated significantly with Broselow lorazepam (r = 0.963, P < 0.0001) and epinephrine (r = 0.966, P < 0.0001) doses.

CONCLUSIONS

Anthropometric estimates and medication dose recommendations provided by AiRDose strongly correlate with established techniques. Further study will establish the feasibility of using AiRDose to accurately obtain weight estimates and medication doses for pediatric patients in the prehospital setting.