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Parpucu UM, Şahin N. The Effect of the Ultrasonography Measurement Method and the Conventional Measurement Method Used in Endotracheal Tube Size Selection in the Pediatric Patient Group on Postextubation Complications and Patient Recovery. Cureus 2023; 15:e46184. [PMID: 37779680 PMCID: PMC10540241 DOI: 10.7759/cureus.46184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/03/2023] Open
Abstract
INTRODUCTION In this study, we aimed to compare the cuffed intubation tube selected with the Cole formula and tracheal ultrasonography (USG) measurement method regarding postextubation complications in providing airway patency and determine its effects on patient recovery. MATERIALS AND METHOD Between 01 July 2022 and 30 June 2023, American Society of Anesthesiologists (ASA) risk group I-III, 4-6-year-old patients who underwent pediatric orthodontic surgery (multiple tooth extraction) were included in the study. Data of age, gender, weight, ASA risk group, history, Cole formula, USG measurement results used in the endotracheal tube (ETT) selection (one of the two whichever application was used), fasting time, intubation success, operation time, 30th-minute modified Aldrete recovery score (MASS), and postoperative complications due to intubation (within the first postoperative hour) were analyzed retrospectively. The patients were divided into two groups according to the method used by the anesthesiologists in selecting the ETT at the beginning of the operation. The group that used Cole formula management was named I, while the group that used the USG measurement method was called II. Intubation-related complication data of the patients in the first 1 hour postoperatively and MASS values at the 30th minute were compared between the groups. RESULTS In this study, 52.5% of the cases were male (n=42), 47.5% were female (n=38), the mean age was 4.84±0.84 years, and the mean body weight was 22.56±7.58 kilogram. There was no statistically significant difference between the groups regarding age, gender, body weight, ASA score, operation time, and period without oral consumption. ETT diameter measurement values according to groups were 4.73±0.46 mm in Group I and 4.41±0.61 mm in Group II. Postoperative 30th-minute MASS values were median 7 in Group I and median 8 in Group II (p<.001). MASS values were significantly higher in the Group II patient group. Intubation-related complications (postoperative cough, stridor, laryngospasm, tachypnea, wheezing, dysphonia) were observed in Group I with a rate of 40% within the first postoperative hour, while complications were marked with a rate of 17.5% in Group II (p=0.026). Complications in group II were significantly lower. CONCLUSION In the pediatric age group, especially under the age of 6, trachea measurement with USG and ETT selection is an effective, safe, and noninvasive method compared to other conventional methods. ETT size selection with USG accelerates postoperative patient recovery and reduces the risk of intubation-related complications. In addition, inflating the tube cuff under USG guidance can prevent cuff-related complications.
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Affiliation(s)
- Umit Murat Parpucu
- Department of Anesthesiology and Reanimation, Gulhane Faculty of Health Sciences, University of Health Sciences, Ankara, TUR
| | - Nilgün Şahin
- Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, TUR
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Tareerath M, Mangmeesri P. Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy. EAR, NOSE & THROAT JOURNAL 2023; 102:193-197. [PMID: 33559493 DOI: 10.1177/0145561320980511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index. PATIENTS AND METHODS Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes. RESULTS Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients. CONCLUSION Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < -2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance.
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Affiliation(s)
- Matula Tareerath
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
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Muacevic A, Adler JR, Francis J, Kumar M, Singha SK, Shukla A. Applicability of the Broselow Pediatric Emergency Tape to Predict the Size of Endotracheal Tube and Laryngeal Mask Airway in Pediatric Patients Undergoing Surgery: A Retrospective Analysis. Cureus 2023; 15:e33327. [PMID: 36741616 PMCID: PMC9894818 DOI: 10.7759/cureus.33327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/05/2023] Open
Abstract
Background This study aims to elucidate the applicability of the Broselow pediatric emergency tape in predicting the size of the endotracheal tube (ET) and laryngeal mask airway (LMA) in children of central India. Methods A retrospective review was conducted in the Department of Pediatric Surgery during the period of four years (January 2018 to December 2021), and all children between 1 month and 12 years of age who were admitted for routine surgery and were operated on were included. The goal was to assess the accuracy of Broselow pediatric emergency tape in predicting the size of ET and LMA in children and assess the applicability of this tape in an Indian setting based on observation and comparison with the predicted ET tube and LMA size based on the tape. The correlation was done between the predicted ET tube and LMA size and used ET tube and LMA size (the difference and mean). The Chi-square test was applied to test the difference between those matching and those not matching with their respective color zones with respect to weight, tracheal tube (LMA/ET) tube, and for both weight and tracheal tube, and then the p-value was calculated. A p-value of less than 0.05 was considered to be significant. Results A total of 296 patients were included in the study. There were 230 males and 66 females. A maximum number of patients were in the white zone (56 patients). A total of 112 patients (37.8%) matched the zone with their weight; 192 patients (64.8%) matched their LMA/ET tube with their respective zones; 81 patients (27.36%) matched both their weights and tracheal tube (LMA/ET) size with the predicted values as per their respective zones. Pearson's Chi-square test was applied to assess the significance of the difference between the number of patients matching and not matching their weight, LMA/ET tube, and both weight and LMA/ET tube with their corresponding color zones as per the Broselow tape. For all the above parameters, the differences were found to be not significant for p-value <0.05. Conclusions Broselow tape (BT) is applicable in acute trauma settings where it can be used for estimating weight and ET/LMA sizes in an emergency situation where weight measurement is not feasible.
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Saeed W, Akbar A, Waseem M, Kuchinski AM, Xu H, Gibson RW. Addition of Midthigh Circumference Improves Predictive Ability of Broselow Tape Weight Estimation. Pediatr Emerg Care 2022; 38:448-452. [PMID: 35686959 DOI: 10.1097/pec.0000000000002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to improve the accuracy of Broselow tape (BT) weight prediction by adding midthigh circumference (MTC) and to compare and standardize the methods for measuring MTC. METHODS This prospective, observational study was conducted in a pediatric emergency department of a tertiary care children's hospital. Children up to 12 years of age presenting to emergency department were included. Children were excluded if obtaining the data would interfere with their acute management. The data collected included MTC, height, BT weight, and actual weight. Three models were built. Broselow tape-only model and MTC plus BT model used 2 methods for MTC measurements: visual approximation of thigh midpoint (visual MTC1) and Centers for Disease Control and Prevention (CDC)-defined method (CDC MTC2). RESULTS A total of 430 children were enrolled during pre-coronavirus disease era. Of these, 234 were boys (54.4%) and 196 (45.6%) were girls. Data were categorized into children younger than 2 years (224 [52.1%]) and older than 2 years (206 [47.9%]). African American constituted 250 (58%); White, 136 (31%); and unspecified, 27 (6%). For the entire cohort, both models that included MTC were significantly better at weight prediction with larger adjusted R2 (visual MTC1, 0.921; CDC MTC2, 0.928) and smaller root mean squared (RMSE) (visual MTC1, 2.70; CDC MTC2, 2.56) compared with BT-only model (adjusted R2 = 0.843; RMSE, 3.80). Midthigh circumference plus BT models performed even better in children older than 2 years compared with BT-only model with adjusted R2 (visual MTC1, 0.859; CDC MTC2, 0.872 vs 0.616) and RMSE (visual MTC1, 3.18; CDC MTC2, 3.03 vs 5.27). CONCLUSIONS The inclusion of MTC with BT resulted in a more accurate weight prediction in children especially greater than 2 years old. Midthigh circumference model using CDC-defined method was slightly better predictor of actual weight than visual approximation.
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Affiliation(s)
- Wajeeha Saeed
- From the Department of Pediatric Emergency Medicine, Medical College of Georgia, Augusta University
| | - Amber Akbar
- Medical Scholars Program, Medical College of Georgia, Augusta, GA
| | - Muhammad Waseem
- Department of Pediatric Emergency Medicine, Lincoln Medical Center, NY
| | | | - Hongyan Xu
- Population Health Science: Biostats and Data Science, Medical College of Georgia, Augusta University, Augusta, GA
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Masoumi G, Mansouri M, Fathali O. Determining the diagnostic value of tracheal intubation by palpation and auscultation methods compared to the chest X-ray method in children. Acute Crit Care 2022; 37:224-229. [PMID: 35172529 PMCID: PMC9184985 DOI: 10.4266/acc.2021.00787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background It is important to determine the proper location of tracheal tube for proper ventilation. In this study, we compared the diagnostic value of tracheal intubation with two methods of palpation and auscultation with chest X-ray (CXR) method in pediatric. Methods In this interventional study, 80 patients under 6 years of age were included. After tracheal intubation appropriate depth of tracheal tube was determined by auscultation and recorded, then by palpation depth of tracheal tube determined and tube was fixed. The length of the tube was calculated with the standard formula based on age. After surgery, CXR was taken and, according to the landmark, the distance from the end of the tube to the anterior lower tooth was recorded. Results Interclass correlation coefficient (ICC) between the palpation method and the standard method in the number of fixing tracheal intubation was 0.573, which shows the average and significant correlation between these two methods in determining the fixed number of tracheal intubation. ICC between the auscultation and the standard method in fixing tracheal intubation number was 0.430, which shows the average and significant agreement between these two methods in determining the fixed number of tracheal intubation. There is no significant relationship between sex and the average number of fixing tracheal intubation in all methods. Conclusions This study has shown that both palpation and auscultation methods are appropriate, but with a slightly higher palpation ICC, the palpation can be considered relatively better.
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Saeed W, Talathi S, Suneja U, Gupta N, Mandadi AR, Xu H, Leber M, Waseem M. Utility of Body Habitus Parameters to Determine and Improve the Accuracy of the Broselow Tape. Pediatr Emerg Care 2022; 38:e111-e116. [PMID: 32740637 DOI: 10.1097/pec.0000000000002170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aims of this study were to determine and improve accuracy of the Broselow Tape (BT) in estimating children's weight by adding body habitus parameters. METHODS This cross-sectional study was conducted in an urban hospital pediatric clinic. Children up to 8 years old coming in for well-child visit were included. Children with acute illness or presence of any chronic condition potentially resulting in growth disturbance and out of BT height range were excluded. The following body habitus parameters were measured using the Centers for Disease Control and Prevention guidelines: actual weight, predicted weight using BT (BTW), mid-thigh circumference (MTC), body mass index, mid-arm circumference, and waist-to-hip ratio. RESULTS A total of 301 children were enrolled. Of these, 151 were male (50%). Hispanics constituted 160 (53.2%). There was a positive linear association between BTW and actual weight in the overall cohort (adjusted R2 = 0.9164, P < 0.001). However, there was a difference in this association among children younger than 2 years and children older than 2 years (adjusted R2 = 0.89 vs 0.4841). Incorporating MTC and/or waist circumference along with BTW in the model increased the accuracy, providing a better estimate of actual weight (adjusted R2 = 0.94, P < 0.001). CONCLUSIONS We conclude that there might be inaccuracies in the weight predicted by BT in our patient population, especially those weighing more than 15 kg and older than 2 years. Our study also demonstrates that MTC correlates closely with the actual weight and could be used in addition to BT for more accurate weight estimation.
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Affiliation(s)
- Wajeeha Saeed
- From the Department of Pediatric Emergency Medicine, Medical College of Georgia/Augusta University, Augusta, GA
| | - Saurabh Talathi
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition
| | - Upma Suneja
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition
| | - Neha Gupta
- Pediatric Critical Care Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Akhila Reddy Mandadi
- Department of Pediatric Emergency Medicine, The University of Florida College of Medicine, Jacksonville, FL
| | - Hongyan Xu
- Department of Population Health Science: Biostats & Data Science, Medical College of Georgia/Augusta University, Augusta, GA
| | - Mark Leber
- Department of Emergency Medicine, Brooklyn Hospital Center, Brooklyn
| | - Muhammad Waseem
- Department of Pediatric Emergency Medicine, Lincoln Medical Center, NY
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Gunjan, Ankesh, Faseehullah MA. Is Ultrasonography a Better Method of Endotracheal Tube Size Estimation in Pediatric Age Group than the Conventional Physical Indices-Based Formulae? Anesth Essays Res 2021; 14:561-565. [PMID: 34349320 PMCID: PMC8294422 DOI: 10.4103/aer.aer_115_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Providing safe anaesthesia to paediatric patients is a challenging task. This requires a thorough knowledge of the soft and pliable paediatric airway. Owing to the vulnerability of the anatomical structures involved, choosing an appropiate sized endotracheal tube (ETT) is important in these cases. A larger sized ETT may lead to trauma and a smaller one would result in leakage and risk of aspiration. Both situations demand an immediate tube change, thereby complicating the condition. The physical indices- based formulae have often failed to justify the purpose leading to repeated laryngoscopy and tube change during intubation. The increase in availability of the modern ultrasound devices have shown promise in these cases. Aims and Objectives: In this study we examine the accuracy of ultrasonography (USG)to assess the appropriate ETT size, comparing it with physical indices based formulae suggested ETT size so that repeated attempts on intubation can be minimized. Materials and Methods: The study group included 100 patients of 1-5 years, ASA I- II, requiring orotracheal intubation under general anaesthesia. The tracheal sub-glottic diameter was estimated by pre-anaesthetic USG to determine the ETT size, both cuffed and uncuffed. ETT data obtained by these methods were compared by Pearson's correlation coefficient and t-test. Results: USG predicted ETT size were significantly more consistent than the physical indices based formulae. Also the age based formulae were found to be more precise than the height based ones. Seven patients required change of tube once. Conclusion: Ultrasonography is an effective tool in predicting paediatric ETT size.
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Affiliation(s)
- Gunjan
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ankesh
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Md Alam Faseehullah
- Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Lee J, Kim DK, Kang EK, Kim JT, Na JY, Park B, Yeom SR, Oh JS, Jhang WK, Jeong SI, Jung JH, Choi YH, Choi JY, Park JD, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 6. Pediatric basic life support. Clin Exp Emerg Med 2021; 8:S65-S80. [PMID: 34034450 PMCID: PMC8171176 DOI: 10.15441/ceem.21.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/06/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Bobae Park
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Seok Ran Yeom
- Department of Emergency Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Children's Hospital Asan Medical Center, Seoul, Korea
| | - Soo In Jeong
- Department of Pediatrics, Ajou University Hospital, Suwon, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Choi YH, Kim DK, Kang EK, Kim JT, Na JY, Park B, Yeom SR, Oh JS, Lee J, Jhang WK, Jeong SI, Jung JH, Choi JY, Park JD, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 7. Pediatric advanced life support. Clin Exp Emerg Med 2021; 8:S81-S95. [PMID: 34034451 PMCID: PMC8171177 DOI: 10.15441/ceem.21.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/28/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Bobae Park
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Seok Ran Yeom
- Department of Emergency Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Children's Hospital, Asan Medical Center, Seoul, Korea
| | - Soo In Jeong
- Department of Pediatrics, Ajou University Hospital, Suwon, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Fenley H, Voorman M, Dove JT, Greene JS. Predicting pediatric tracheal airway size from anthropomorphic measurements. Int J Pediatr Otorhinolaryngol 2020; 134:110020. [PMID: 32251974 DOI: 10.1016/j.ijporl.2020.110020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/10/2020] [Accepted: 03/22/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine the relationship between body mass index and tracheal airway size in children. METHODS Retrospective case series. CT or MRI images of the neck of 171 pediatric patients obtained from 2000 to 2010 at a tertiary pediatric hospital were analyzed. Age, gender, height, weight, BMI and CDC weight classification for each patient were compared with axial CT measurements (AP diameter and width) and calculated cross-sectional airway area. Linear regression models were performed to identify factors predictive of airway size. RESULTS Age ranged from 2 to 20 years. Weight was the most significant predictor of tracheal AP diameter (P = 0.029), with height also approaching statistical significance (P = 0.051). Tracheal width was best predicted by height (P = 0.09). Weight was the only statistically significant predictor of cross-sectional tracheal area (P = 0.002). Body mass index was not a statistically significant predictor of airway size in any dimension; however, there was an obvious trend towards decreasing tracheal width and cross-sectional area in patients with BMI of 25 or greater. CONCLUSION In pediatric patients, estimation of endotracheal or tracheostomy tube size should take into account height, weight and BMI in addition to the patient's age. Patients with elevated BMI may have smaller tracheal sizes in various dimensions than normal or low-weight patients.
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Affiliation(s)
- Heather Fenley
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17821, USA.
| | - Matthew Voorman
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17821, USA
| | - James T Dove
- Department of General Surgery, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17821, USA
| | - Joseph Scott Greene
- Department of Otolaryngology - Head and Neck Surgery, Geisinger Health System, 100 North Academy Avenue, Danville, PA, 17821, USA
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How Accurate Are Pediatric Emergency Tapes? A Comparison of 4 Emergency Tapes With Different Length-Based Weight Categorization. Pediatr Emerg Care 2020; 36:e151-e155. [PMID: 28697158 DOI: 10.1097/pec.0000000000001212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pediatric emergency tapes have been developed to support paramedics and emergency physicians when dosing drugs and selecting medical equipment in pediatric emergency situations. The aim of this study was to compare the accuracy of 4 pediatric emergency tapes to correctly estimate patient's weight based on a large population of patients. METHODS Patients undergoing general anesthesia between January 2012 and March 2015 with documented age, sex, body weight, and length were identified from the electronic anesthesia patient data management system of the Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland. Weight estimation by means of the Broselow-Tape, the Pädiatrisches Notfalllineal, the Paulino System, and the Kinder-Sicher were compared with true patient's weight. Percentages of estimated body weight within a ±10% and ±20% interval were calculated. Data are median (interquartile range) or count (percent); statistical calculations were done with McNemar and Bonferroni correction. RESULTS A total of 3307 patients were identified with complete data sets, 1930 (58.4%) were male, median age was 4.1 years (1.1-8.2 years), median length 101.0 cm (74.0-126.0 cm) and median patient weight 15.8 kg (9.2-25.0 kg). The proportion weight estimation within the ±10% and the ±20% interval was the highest in the Broselow-Tape with 54.0% and 81.5% (P < 0.001 and P = 0.003), followed by the Pädiatrisches Notfalllineal (50.5% and 79.8%), Paulino System (49.9% and 78.0%) and Kinder-Sicher (48.2% and 77.5%). CONCLUSIONS The overall accuracy of all 4 emergency tapes tested is poor and including a larger number of weight categories does not necessarily increase accuracy. Other strategies have to be developed to improve weight estimation in pediatric emergency situations.
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Iloh ON, Edelu B, Iloh KK, Igbokwe OO, Ndu IK, Nduagubam OC, Akubuilo UC, Obumneme-Anyim IN, Eze JN, Osuorah CDI. Weight estimation in Paediatrics: how accurate is the Broselow-tape weight estimation in the Nigerian child. Ital J Pediatr 2019; 45:146. [PMID: 31744529 PMCID: PMC6862825 DOI: 10.1186/s13052-019-0744-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Determination of weight in children is an important aspect of their assessment. It has a wide range of usefulness including assessing their nutritional status and drug dose calculation. Despite its usefulness, weight estimation in children in certain conditions can be challenging particularly in emergency situations or in children who are severely ill or cannot stand on standard scales. The Broselow Tape which is a validated tape that is used to estimate weight based on length was developed using height/weight correlations from Western data. However, considering the variations in anthropometric measurements of children from different geographic locations, there is need to ascertain how accurate it is to estimate weight using the Broselow tape among children in Nigeria. Aim The study was carried out to determine the accuracy in the use of the Broselow Tape in weight estimation among Nigerian children. Method A total 1456 children aged 1–12 years who satisfied the inclusion criteria were enrolled over a 2½ year period from two tertiary health facilities in Enugu state Nigeria. Weight was taken using standard weighing scale and Broselow tape. Data collected was analysed using SPSS. Result Of the 1456 children studied, majority (84.2%) had normal Body-Mass-Index (BMI) while about 4.6% had a low BMI percentile for age. The mean weight difference between the two methods was not significantly different between the 1 to 6 years old category. Significant differences were observed from 7 up to 12 years. The Broselow Tape overestimated weights in 1 year old by 3.88%, 2 years 1.58%, 3 years by 2.13%, 4 years (1.94%) and 5 year (0.07%). After 5 years, the degree of overestimation rises sharply to 4.25% in 6, 9.25% in 7, 7.29% in 8 and 9.29%. 9.18, 11.61% & 6.75% in 9, 10, 11 and 12 years old respectively. The proportion of estimated weights that was within 10- 20% of the actual weight was higher in the 1-6 years age categories compared to weight estimates in older age categories. Conclusion Weight estimates obtained using the Broselow tape correlated better in children that are 6 years or younger compared to those in the older age categories. There is need for re-validation and/or adjustments of the Broselow tape especially in children over 6 years old.
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Affiliation(s)
| | - Benedict Edelu
- University of Nigeria Teaching Hospital, Nsukka, Nigeria
| | | | | | - Ikenna K Ndu
- Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
| | - Obinna C Nduagubam
- Enugu State University of Science and Technology, Enugu, Enugu State, Nigeria
| | | | | | - Joy N Eze
- University of Nigeria Teaching Hospital, Nsukka, Nigeria
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Haider G, Lorinson K, Lorinson D, Auer U. Development of a clinical tool to aid endotracheal tube size selection in dogs. Vet Rec 2019; 186:157. [PMID: 31530720 DOI: 10.1136/vr.105065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/30/2019] [Accepted: 08/28/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify phenotypic parameters correlating with the inner tracheal diameter (ITD) and endotracheal tube size (ETS) in adult dogs and to develop a chart for ETS estimation. METHODS Five-hundred and forty-four adult dogs; 100 dogs were enrolled prospectively and 444 dogs retrospectively. Different phenotypic parameters, the ITD on latero-lateral radiography and ETS were prospectively measured in dogs that underwent general anaesthesia. The parameter correlated best with the ITD was used to develop a graphic chart for ETS estimation. The accuracy of this chart was then retrospectively tested. RESULTS In prospective cohort, the correlation between body size and body mass and ITD (r=0.85 and r=0.84) was good, and the highest correlation observed between ETS and body mass (rs=0.92, P<0.001). In the retrospective assessment, the mean difference between the predicted and used ETS was 0.0 (sd±0.84) for mesocephalic/dolicocephalic (MDC) dogs, showing high accuracy, but for brachycephalic dogs, it was 1.3 (sd±0.98). CONCLUSION A graphic chart for ETS selection in dogs, using body mass, was designed in this study and was demonstrated to be accurate for ETS prediction in MDC dogs but not in brachycephalic dogs.
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Affiliation(s)
- Georg Haider
- AniCura Regionsdjursjukhuset Bagarmossen, Bagarmossen, Sweden
| | - Karin Lorinson
- Chirurgisches Zentrum für Kleintiere, Vösendorf, Austria
| | | | - Ulrike Auer
- Anaesthesia, Veterinarmedizinische Universitat Wien, Wien, Austria
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Abstract
BACKGROUND An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors. OBJECTIVES This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals. METHODS Using an electronic medical record database, 79,000 emergency department encounters of children younger than 5 years were analyzed. Extreme weights were first identified using weight percentiles. Encounters with potential weight errors were further evaluated using a retrospective chart review to determine whether a weight error and medication-dosing error occurred. RESULTS The percentage of weight errors of total encounters at all 3 institutions was low (0.63% on average), but a large proportion of weight errors led to subsequent medication-dosing errors (34% on average). The children's hospital did not have clinically significantly lower occurrences of weight errors or weight-based medication errors. Common weight errors included the weight in pounds being substituted for the weight in kilograms and decimal placement errors. CONCLUSIONS Weight errors were uncommon at the 3 emergency departments that we studied, but they led to weight-based medication-dosing errors that had the potential to cause harm.
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Oofuvong M, Nuanjun K, Sangkaew T, McNeil E. Prediction of uncuffed tracheal tube sizes in children and infants using age/weight-based formulae: A retrospective cross-sectional study. Int J Pediatr Otorhinolaryngol 2019; 122:105-110. [PMID: 30999158 DOI: 10.1016/j.ijporl.2019.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The age-based formula is commonly used to predict tracheal tube (TT) sizes although its inaccuracy has been reported to reach as high as 60%. We aim to determine a practical formula using age in months and weight in kilograms to predict uncuffed tracheal tube (TT) size in children and infants. METHODS A retrospective cross-sectional study was conducted on data obtained from a prospective study on children aged less than 9 years who came for elective surgery and received general anesthesia with oroendotracheal tube intubation at Songklanagarind Hospital between September 2008 and December 2012. The uncuffed TT sizes were based on the age-based formulae and the discretion of the attending anesthesiologist. The age (in months), weight (in kg), and final TT size were measured. Univariate and multivariate linear regression analyses were used to find potential predictors of final uncuffed TT size and therefore the best formula. The correlation coefficient (r) for each model was calculated. The kappa statistic was used to measure the agreement between predicted and actual TT size. RESULTS A total of 668 patients were recruited. The age/weight formulae for infants aged ≤12 months and children aged >12 months were 3.15 + (age [months] × 0.05) + (weight [kg] × 0.05) with r value of 0.75 (n = 216) and 3.83 + (age [months] × 0.017) + (weight [kg] × 0.017) with r value of 0.85 (n = 452), respectively. The formulae correctly predicted 69.0% and 65.0% of actual TT sizes for infants and children, respectively (both p < 0.001). The formulae for malnourished infants and children whose weights were less than the 3rd percentile for age were 2.70 + (weight [kg] × 0.21) (n = 43) and 3.59 + (age [months] × 0.012) + (weight [kg] × 0.056) (n = 105) with r values of 0.81 and 0.87, respectively. CONCLUSION The age/weight formula can be used to estimate TT size in infants and children. In failure to thrive children, our formula for malnourished children and infants provided high correlation with final TT sizes.
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Affiliation(s)
- Maliwan Oofuvong
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Kanjana Nuanjun
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Tidarut Sangkaew
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Kumar MG, Atteri M, Batra YK, Yaddanapudi L, Yaddanapudi S. Derivation and validation of a formula for paediatric tracheal tube size using bootstrap resampling procedure. Indian J Anaesth 2019; 63:444-449. [PMID: 31263295 PMCID: PMC6573043 DOI: 10.4103/ija.ija_39_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS The accuracy of age-, length- and weight-based formulae to predict optimal size of uncuffed tracheal tubes (TTs) in children varies widely. We determined the accuracy of age, length and weight in predicting the size of TT in Indian children, and derived and validated a formula using the best predictor. METHODS In the derivation phase, 100 children aged 1-8 years undergoing general anaesthesia and tracheal intubation with an uncuffed tube were prospectively studied. The correct size of the TT used was confirmed using the leak test. A bootstrap resampling procedure was used to estimate the accuracy of the predictors (age, weight, or length alone; length and age; length and weight; and length, weight and age). The best predictor was used to derive a formula (Paediatric Tube Size Predictor, PTSP) to calculate the size of TT. The accuracy of PTSP was tested in 150 children of the same age group in the validation phase. RESULTS Length (L (in meters), R 2 = 0.61) was the best single predictor of the size of TT and was used to derive the PTSP as internal diameter = 3L + 2.5. In the validation phase, the PTSP predicted the size of TT correctly in 75% of children. Re-intubation was associated with a higher incidence of respiratory morbidity than one-time tracheal intubation. CONCLUSION Length of the child predicts the size of an uncuffed TT better than age and weight. The PTSP formula based on length correctly predicts the size of uncuffed TT in 75% of children.
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Affiliation(s)
- M Ganesh Kumar
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenakshi Atteri
- Department of Anesthesiology and Pain Management, John H Stroger Jr Hospital of Cook County, Chicago, IL, USA
| | - Yatindra K Batra
- Department of Anaesthesia and Pain Management, Max Superspeciality Hospital, Mohali, Punjab, India
| | - Lakshminarayana Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Goto T, Goto Y, Hagiwara Y, Okamoto H, Watase H, Hasegawa K. Advancing emergency airway management practice and research. Acute Med Surg 2019; 6:336-351. [PMID: 31592072 PMCID: PMC6773646 DOI: 10.1002/ams2.428] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/11/2019] [Indexed: 12/11/2022] Open
Abstract
Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.
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Affiliation(s)
- Tadahiro Goto
- Graduate School of Medical Sciences University of Fukui Fukui Japan
| | - Yukari Goto
- Department of Emergency and Critical Care Nagoya University Hospital Nagoya Aichi Japan
| | - Yusuke Hagiwara
- Department of Pediatric Emergency and Critical Care Medicine Tokyo Metropolitan Children's Medical Centre Fuchu Tokyo Japan
| | - Hiroshi Okamoto
- Department of Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Hiroko Watase
- Department of Surgery University of Washington Seattle Washington
| | - Kohei Hasegawa
- Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts
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Doud AN, Gaffley M, Hostetter O, Talton JW, Petty JK. “A-OK”: Chest Radiograph during Primary Survey Facilitates Faster, More Accurate Endotracheal Tube Position in Injured Children. Am Surg 2019. [DOI: 10.1177/000313481908500524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Advanced Trauma Life Support algorithm recommends bedside confirmatory techniques to confirm correct endotracheal tube (ETT) depth, a critical component in the care of pediatric trauma patients. We hypothesized that bedside confirmatory techniques are inaccurate and that early chest X-ray (CXR) would overcome such inaccuracies, allowing for faster intervention of malpositioned ETTs. An “A-OK” algorithm of immediate CXR following intubation in injured children aged <16 years was implemented. Eligible patients the years before and after implementation were identified. The accuracy of bedside confirmatory techniques (use of length-based depths and auscultation of breath sounds) was assessed. Post-“A-OK” patients were compared with pre-“A-OK” controls regarding the speed of malpositioned ETTrepositioning. Twenty-eight post-“A-OK” cases and 23 pre-“A-OK” controls were identified. The groups did not differ in baseline characteristics. Bedside confirmatory techniques were accurate in only 61 per cent (length-based depth) and 58 per cent (auscultation of breath sounds) of patients. Time to ETT repositioning was significantly longer in pre-“A-OK” controls than in post-“A-OK” cases (35.2 ± 15.9 minutes vs 21.1 ± 11.8 minutes, P = 0.03). Bedside confirmatory techniques to determine ETT positioning are inaccurate in children. Inclusion of CXR in the primary survey is safe and allows for more rapid repositioning of malpositioned ETTs.
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Affiliation(s)
- Andrea N. Doud
- Department of General Surgery, University of Louisville School of Medicine, Louisville, Kentucky
- Childress Institute for Pediatric Trauma, Winston-Salem, North Carolina
| | - Michaela Gaffley
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Olivia Hostetter
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
| | - Jennifer W. Talton
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John K. Petty
- Childress Institute for Pediatric Trauma, Winston-Salem, North Carolina
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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Abstract
BACKGROUND Accurate weight estimation is important for calculating appropriate medication dosages, determining rates of fluid replacement, and selecting correct equipment sizes in critically ill children requiring resuscitation. The actual measurement of the weight of a critically ill or injured child is often not possible. The Broselow Pediatric Emergency Tape (BT) is an important tool for predicting a child's weight based on his/her height. Although BT has previously been validated, given the increasing prevalence of obesity in today's society, it behooves clinicians relying on this resuscitation aid to revisit the issue. OBJECTIVE The aim of this study was to evaluate the accuracy of the color-coded BT in weight estimation and the influence of obesity on its accuracy. METHODS This is a retrospective study conducted in a pediatric clinic of urban hospital. This study reviewed the medical records of children up to 96 months of age, who presented during 2008-2010. We recorded the child's age (in months), actual (measured) weight (in kilograms), and height (in centimeters). Based on the height, weight estimation was obtained using the color-coded BT. The actual weight was compared with the predicted weight obtained by the height-based BT. Patients presenting with any medical condition that would substantially affect growth of the child were excluded. A univariate logistic regression model was utilized to predict any underestimation based on age, sex, and body mass index (BMI) percentile. RESULTS The medical records of 538 children were reviewed. There was a discrepancy in 226 children (42%). Broselow Pediatric Emergency Tape underestimated weight (measured weight was higher than predicted weight) in 158 children (29.4%) and overestimated (measured weight was lower than predicted weight) in 68 children (12.6%). Of the 158 underestimated children, 138 were off by 1 color zone, 16 by 2 color zones, and 4 by more than 2 color zones. When characterized by BMI, 46 children (13.6%) had normal BMI, 27 (45.8%) were overweight, and 84 (80.8%) were obese, whereas one child (2.8%) was underweight. CONCLUSIONS In our population, BT was inaccurate in predicting weight in 42% of children (underestimation in 158 children [29.4%] and overestimation weight in 68 children [12.6%]). However, the majority of discrepancies involved only 1 BT color zone. Emergency physicians should be aware of this discrepancy until more accurate methods become available.
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Booysen K, Dippenaar JM, Smith FJ. Validation of age-based body mass estimation methods in toddlers and pre-school children. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2019. [DOI: 10.1080/22201181.2018.1532676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Uzumcugil F, Celebioglu EC, Ozkaragoz DB, Yilbas AA, Akca B, Lotfinagsh N, Celebioglu B. Body Surface Area Is Not a Reliable Predictor of Tracheal Tube Size in Children. Clin Exp Otorhinolaryngol 2018; 11:301-308. [PMID: 30139232 PMCID: PMC6222187 DOI: 10.21053/ceo.2018.00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022] Open
Abstract
Objectives The age-based Cole formula has been employed for the estimation of endotracheal tube (ETT) size due to its ease of use, but may not appropriately consider growth rates among children. Child growth is assessed by calculating the body surface area (BSA). The association between the outer diameter of an appropriate uncuffed-endotrachealtube (ETT-OD) and the BSA values of patients at 24–96 months of age was our primary outcome. Methods Cole formula, BSA, age, height, weight and ultrasound measurement of subglottic-transverse-diameter were evaluated for correlations with correct uncuffed ETT-OD. The Cole formula, BSA, and ultrasound measurements were analyzed for estimation rates in all patients and age subgroups. The maximum allowed error for the estimation of ETT-OD was ≤0.3 mm. Patients’ tracheas were intubated with tubes chosen by Cole formula and correct ETT-OD values were determined using leak test. ETT exchange rates were recorded. Results One-hundred twenty-seven patients were analyzed for the determination of estimation rates. Thirteen patients aged ≥72 months were intubated with cuffed ETT-OD of 8.4 mm and were accepted to need uncuffed ETT-OD >8.4 mm in order to be included in estimation rates, but excluded from correlations for size analysis. One-hundred fourteen patients were analyzed for correlations between correct ETT-OD (determined by the leak test) and outcome parameters. Cole formula, ultrasonography, and BSA had similar correct estimation rates. All three parameters had higher underestimation rates as age increased. Conclusion. The Cole formula, BSA, and ultrasonography had similar estimation rates in patients aged ≥24 to ≤96 months. BSA had a correct estimation rate of 40.2% and may not be reliable in clinical practice to predict uncuffedETT-size.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Demet Basak Ozkaragoz
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Aysun Ankay Yilbas
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Basak Akca
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nazgol Lotfinagsh
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bilge Celebioglu
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
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Effectiveness of endotracheal-tube size by age-based formula for Thai pediatric cardiac patients: a retrospective study. ASIAN BIOMED 2018. [DOI: 10.2478/abm-2010-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract
Background: Pediatric patients with congenital heart diseases may have pathological airway abnormality and delayed development. To predict the appropriate size of endotracheal tube (ETT), a formula between diameter and age has been widely used for Western normal children. However, it is unclear whether this age-based (AB) formula is applicable to Thai pediatric cardiac patients. Objective: Evaluate the effectiveness of uncuffed ETT size by AB formula for pediatric cardiac patients. Methods: A retrospective study was conducted using 320 cases of non-cardiac and cardiac patients aged 2-7 years old who were orally intubated with a regular uncuffed ETT at Siriraj Hospital, Thailand. The exclusion criteria were history of tracheostomy, upper airway obstruction, and expected difficult intubation. Demographic data and final ETT used were recorded. Results: The tube- size predicted by the AB formula could be applied to 54.4% of non-cardiac and 48.1% of cardiac patients (p= 0.314), whereas three sizes of tubes (one above and one below the predicted size) covered 96.9% and 94.4% of non-cardiac and cardiac patients, respectively (p = 0.413). The ETT with 0.5 mm in ID larger than the predicted size were more often used in 35.0% of cardiac patients compared with 22.5% of non-cardiac patients (p= 0.019). There were no significant differences between methods using age (actual, round-up, and truncated) to calculate the AB formula. The Pearson’s correlation between the ID of the ETT with height in non-cardiac and cardiac patients were 0.430 and 0.683, respectively (p <0.001), whereas correlations with weight were 0.622 and 0.561 (p <0.001), respectively. Conclusion: The AB formula was applicable to non-cardiac and cardiac children aged 2-7 years old. For Thai pediatric cardiac patients, we recommend to use a one-size larger ETT than non-cardiac patients.
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Jang M, Basa K, Levi J. Risk factors for laryngeal trauma and granuloma formation in pediatric intubations. Int J Pediatr Otorhinolaryngol 2018; 107:45-52. [PMID: 29501310 DOI: 10.1016/j.ijporl.2018.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Intubation has been associated with laryngeal injury that often resolves spontaneously without complication. We present a case of a child intubated for less than 48 hours, who presented with dysphonia and intermittent dyspnea two months after intubation due to epiglottic and vocal process granulomas. This is unusual in that multiple granulomas were found in the posterior glottis and supraglottis after short-term intubation. Our objective was to determine if there are risk factors for developing persistent post-intubation sequelae, including the delayed presentation and unusual location of post-intubation granulomas in our case. STUDY DESIGN Case report and systematic literature review. METHODS Pubmed database, which is inclusive of MEDLINE, was used to perform a literature review with the search terms ((pediatric OR children OR neonatal OR infant) AND (laryngeal OR supraglottic) AND intubation AND (granuloma OR injury OR complication)). Only English language results were reviewed. Titles and abstracts from 379 results were reviewed. Full text was reviewed from all original studies which included human pediatric subjects and endoscopic examinations after endotracheal intubation. RESULTS In our case, laryngeal granuloma size reduced significantly after starting anti-reflux medications. The remainder was removed with laryngeal microdebrider with no recurrence at 3 weeks and 2.5 years post-operatively. Overall, 28 of the 379 studies reviewed identified evidence of laryngeal trauma due to intubation, however only 6 studies documented any type of supraglottic injury. Risk factors identified for developing post-intubation sequelae included intubation duration greater than 24 h; trauma to the larynx via various mechanisms including traumatic intubation, need for reintubation and tube changes, and increased movement while intubated; and presence of respiratory tract infection during intubation. CONCLUSION Trauma to the larynx during intubation should be avoided to minimize post-intubation injury in pediatric patients, by using appropriate intubation protocols, endotracheal tube size, and adequate sedation.
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Affiliation(s)
- Minyoung Jang
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jessica Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Shrestha K, Subedi P, Pandey O, Shakya L, Chhetri K, House DR. Estimating the weight of children in Nepal by Broselow, PAWPER XL and Mercy method. World J Emerg Med 2018; 9:276-281. [PMID: 30181796 DOI: 10.5847/wjem.j.1920-8642.2018.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Resuscitation of a critically-ill child requires an accurate weight for fluids and medication dosing; however, weighing children on a scale while critically ill is not always practical. The objective of this study is to determine the accuracy of three different weight estimation methods (Broselow, PAWPER XL and Mercy tape) of children presenting to Patan Hospital, Nepal. METHODS This was a prospective, cross-sectional study that included children presenting to the emergency department and under-fourteen outpatient clinic at Patan Hospital. Measured weight was compared to estimated weight of Broselow, PAWPER XL, and Mercy tapes. The mean percentage error and percentage of estimated weights that were within 10% (PW10) and 20% (PW20) of actual weight were calculated. Acceptable accuracy was determined as a PW10>70% and PW20>95%. A Bland-Altman analysis was done to determine agreement between each weight estimation method and actual weight. RESULTS The study included 813 children. The mean age was 4.2 years (ranging from 4 days to 14 years) with 60% male. The mean percentage error (MPE) for Broselow, PAWPER XL and Mercy were -1.0% (SD 11.8), 0.7% (10.5) and 4.2% (11.9) respectively. The predicted weight within 10% was highest for the PAWPER XL (71.5%) followed by Broselow (63.2%) and Mercy (58.1%). The predicted weight within 20% of actual weight was 95.2%, 91.5% and 91.3% for PAWPER XL, Broselow and Mercy respectively. CONCLUSION The PAWPER XL tape was the only method found to be accurate in estimating the weight of Nepalese children.
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Affiliation(s)
- Karun Shrestha
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Prakriti Subedi
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Oshna Pandey
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Likhita Shakya
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Kailash Chhetri
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Darlene R House
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal.,Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Both C, Schmitz A, Buehler PK, Wittwer J, Weiss M, Schmidt AR. Comparison of a paediatric emergency ruler with a digital algorithm for weight and age estimation. Acta Anaesthesiol Scand 2017; 61:1122-1132. [PMID: 28791696 DOI: 10.1111/aas.12949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/03/2017] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Emergency tapes like the "Paediatric-Emergency-Ruler" (PaedER) provide drug dosing and recommend medical airway equipment based on estimated patient bodyweight and age. Previous studies have revealed unsatisfactory accuracy in bodyweight estimation, due to the tapes' length-based weight categories. Therefore, we developed a digital algorithm allowing continuous length-based estimation of weight and age. The aim of this study was to compare the new algorithm with the PaedER regarding accuracy in estimating bodyweight and recommendation of medical airway equipment. METHODS Patients with a body length suitable for the PaedER were included in this single centre, prospective clinical observation trial after obtaining informed written parental consent. Bodyweight estimations by the algorithm and PaedER within ± 10% and ± 20% of the actual bodyweight were compared. Furthermore, medical airway equipment suggested by the PaedER and algorithm were compared with the equipment actually used for anaesthesia. Wilcoxon- and McNemar-Tests were used for statistical analysis. Results are median (interquartiles), P < 0.05 was considered significant. RESULTS In total, 489 patients aged 2.0 years (0.4-5.9), with a body length of 89.0 cm (63.5-114.5), weighing 12.8 kg (6.3-19.6), were included. The algorithm's precision of bodyweight estimation within ± 10%/± 20% was significantly higher at 64.0%/91.6% than the PaedER at 55.4%/81.8% (P < 0.001). Compared to PaedER the algorithm showed a higher incidence of correctly recommended medical airway equipment based on its accuracy for age and bodyweight estimation. CONCLUSION The new digital algorithm is an alternative to conventional emergency tapes, showing improved accuracy regarding length-based estimation of bodyweight and recommendation of medical airway equipment.
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Affiliation(s)
- Ch. Both
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
| | - A. Schmitz
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
| | - P. K. Buehler
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
| | - J. Wittwer
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
| | - M. Weiss
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
| | - A. R. Schmidt
- Department of Anaesthesia and Children's Research Centre; University Children's Hospital; Zurich Switzerland
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Altun D, Orhan-Sungur M, Ali A, Özkan-Seyhan T, Sivrikoz N, Çamcı E. The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients. Paediatr Anaesth 2017; 27:1015-1020. [PMID: 28846176 DOI: 10.1111/pan.13220] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this prospective study was to investigate the success of ultrasound in pediatric patients in determining the appropriate sized cuffed endotracheal tube and to compare the results with conventional height-based (Broselow) tape and age-based formula tube size. METHODS One hundred and fifty-two children of 1-10 years of age, who received general anesthesia for adenotonsillectomy were enrolled to the study. In all participants, the transverse diameter of the subglottis was measured with ultrasound during apnea. An endotracheal tube was chosen with the outer diameter matched to the measured subglottic airway diameter. An age-based (Motoyama-Khine) and height-based (Broselow) endotracheal tube size was calculated. If there was resistance to passage of the tube into the trachea or an airway pressure >25 cmH2 0 was required to detect an audible leak, the endotracheal tube was replaced with internal diameter of 0.5 mm smaller. If there was an audible leak at airway pressure <10 cmH2 O, or peak pressure >25 cmH2 0 or a cuff pressure > 25 cmH2 O was required to seal, the tube was changed to the 0.5 mm larger internal diameter. Best-fit tube internal diameter was the resultant tube internal diameter that met the previously stated conditions. The need for endotracheal tube replacement and peak airway pressure were recorded. RESULTS The internal diameter of ultrasound determined tube was the same as best-fit tube in 88% of children. Endotracheal tube was replaced in 15 patients with a one size larger, and in three patients with one size smaller tube. Using Bland-Altman analysis, a better agreement was observed with ultrasound measurement rather than height-based estimation and age-based formulas. CONCLUSION Our findings show that subglottic diameter measured by ultrasound appears to be a reliable predictor for the assessment of the subglottic diameter of the airway in estimating appropriate size pediatric endotracheal tube.
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Affiliation(s)
- Demet Altun
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mukadder Orhan-Sungur
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Achmet Ali
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tülay Özkan-Seyhan
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nükhet Sivrikoz
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Çamcı
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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27
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Wells M, Goldstein LN, Bentley A, Basnett S, Monteith I. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis. Resuscitation 2017; 121:9-33. [PMID: 28958796 DOI: 10.1016/j.resuscitation.2017.09.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/31/2017] [Accepted: 09/23/2017] [Indexed: 11/28/2022]
Abstract
AIMS The Broselow tape is widely used as a weight-estimation device and drug-dosing guide aid, but concerns about its accuracy and its efficacy have emerged in the last decade. The aim of this study was to systematically review the literature to analyse the accuracy of the Broselow tape as a weight estimation device and review evidence of its utility as a drug-dosing guide. METHODS This was a MOOSE-driven systematic review and meta-analysis, which focused on studies evaluating the accuracy of the Broselow tape and studies reviewing its use as a drug-dosing aid. MAIN RESULTS The tape has undergone substantial changes over the years, but there was no evidence to show that the changes have improved weight-estimation performance. The weight-estimation accuracy of the tape was suboptimal in all populations, with just over 50% of children receiving an estimation within 10% of their actual weight. The overestimation of weight in low- and middle-income countries was often extreme. This indicated a significant potential for potentially harmful medication errors. The limited available evidence on the value of the tape as a drug-dosing guide indicated that the tape was frequently used incorrectly and contained insufficient information to function without additional resources. CONCLUSIONS The Broselow tape lacked sufficient accuracy as a weight estimation and drug-dosing tool when compared to other available techniques. In addition, the Broselow tape contains insufficient drug-dosing information to function as a complete resuscitation aid without additional material. The frequent rate of incorrect usage of the tape indicated that appropriate training with the tape is mandatory to reduce errors.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Alison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Sian Basnett
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
| | - Iain Monteith
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa.
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A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries. Afr J Emerg Med 2017; 7:S36-S54. [PMID: 30505673 PMCID: PMC6246873 DOI: 10.1016/j.afjem.2017.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction When weight cannot be measured during the management of medical emergencies in children, a convenient, quick and accurate method of weight estimation is required, as many drug doses and other interventions are based on body weight. Many weight estimation methodologies in current use have been shown to be inaccurate, especially in low- and middle-income countries with a high prevalence of underweight children. This meta-analysis evaluated the accuracy of weight estimation systems in children from studies from low- and middle-income countries. Methods Articles from low- and middle-income countries were screened for inclusion to evaluate and compare the accuracy of existing systems and the newer dual length- and habitus-based methods, using standard meta-analysis techniques. Results The 2D systems and parental estimates performed best overall. The PAWPER tape, parental estimates, the Wozniak method and the Mercy method were the most accurate systems with percentage of weight estimates within 10% of actual weight (PW10) accuracies of 86.9%, 80.4%, 72.1% and 71.4% respectively. The Broselow tape (PW10 47.1%) achieved a moderate accuracy and age-based estimates a very low accuracy (PW10 11.8–47.5%). Conclusions The PAWPER tape, the Wozniak method and the Mercy method achieved an acceptable level of accuracy in studies from low- and middle-income countries and should preferentially be used and further advanced for clinical emergency medicine practice. Parental estimates may be considered if the regular caregiver of the child is present and a recent measured weight is known. The Broselow tape and age-based formulas should be abandoned in low- and middle-income country populations as they are potentially dangerously inaccurate.
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29
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Wells M, Goldstein LN, Bentley A. The accuracy of emergency weight estimation systems in children-a systematic review and meta-analysis. Int J Emerg Med 2017; 10:29. [PMID: 28936627 PMCID: PMC5608658 DOI: 10.1186/s12245-017-0156-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/07/2017] [Indexed: 11/16/2022] Open
Abstract
The safe and effective administration of fluids and medications during the management of medical emergencies in children depends on an appropriately determined dose, based on body weight. Weight can often not be measured in these circumstances and a convenient, quick and accurate method of weight estimation is required. Most methods in current use are not accurate enough, but the newer length-based, habitus-modified (two-dimensional) systems have shown significantly higher accuracy. This meta-analysis evaluated the accuracy of weight estimation systems in children. Articles were screened for inclusion into two study arms: to determine an appropriate accuracy target for weight estimation systems; and to evaluate the accuracy of existing systems using standard meta-analysis techniques. There was no evidence found to support any specific goal of accuracy. Based on the findings of this study, a proposed minimum accuracy of 70% of estimations within 10% of actual weight (PW10 > 70%), and 95% within 20% of actual weight (PW20 > 95%) should be demonstrated by a weight estimation system before being considered to be accurate. In the meta-analysis, the two-dimensional systems performed best. The Mercy method (PW10 70.9%, PW20 95.3%), the PAWPER tape (PW10 78.0%, PW20 96.6%) and parental estimates (PW10 69.8%, PW20 87.1%) were the most accurate systems investigated, with the Broselow tape (PW10 55.6%, PW20 81.2%) achieving a lesser accuracy. Age-based estimates achieved a very low accuracy. Age- and length-based systems had a substantial difference in over- and underestimation of weight in high-income and low- and middle-income populations. A benchmark for minimum accuracy is recommended for weight estimation studies and a PW10 > 70% with PW20 > 95% is suggested. The Mercy method, the PAWPER tape and parental estimates were the most accurate weight estimation systems followed by length-based and age-based systems. The use of age-based formulas should be abandoned because of their poor accuracy.
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Affiliation(s)
- Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa. .,, Postnet Suite 429, Private Bag X1510, Glenvista, 2058, South Africa.
| | - Lara Nicole Goldstein
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Alison Bentley
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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30
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Nasr-Esfahani M, Nemati S, Masoumi B, Eshaghiandorche A, Jangjoo AA. A Comparative Study on the Results of Estimating Children's Weights Based on Arm Circumference, Height, and Body Habitus against Estimated Weight Broselow on 2-24 Months Children in Isfahan. Adv Biomed Res 2017; 6:104. [PMID: 28904932 PMCID: PMC5590395 DOI: 10.4103/abr.abr_171_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Resuscitation of children in different treatment wards is a challenge. Given that the pediatric drug dosing is based on weight and weighing is not practical in emergency situations, it is critical to employ a fast, easy, and reliable technique. Hence, this study attempted to evaluate the real weight children against Broselow estimation. Materials and Methods: This cross-sectional study involved 1500 children of 2–24 months referred to Isfahan urban and rural health centers in 2015. Children's estimated weights were measured based on the standard Broselow tape and real weights through a digital scale. The factors such as age, sex, height, arm circumference, head circumference, and living place of children were recorded. The collected data were analyzed through independent t-test, ANOVA, and linear regression using SPSS (version 20). Results: The weight difference of children through Broselow estimation was 0.019 kg, and the correlation coefficient was 0.893 (P > 0.05). The difference sorted by age ranges was significant only in >12 months (P < 0.05). It was estimated at error of 10% to be 68.9% correctly. The mean weight estimation error was significant sorted by weight, sex, habitus, and living place of children (P < 0.001). Conclusion: Although Broselow tape has been proved to be accurate it led to a significant error at different age ranges. Hence, the present study estimated the age, arm circumference, and height of Iranian children based on new formulas providing more successful tool through controlling the confounding factors in estimating the real weight.
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Affiliation(s)
| | - Sirous Nemati
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Masoumi
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Eshaghiandorche
- Department of Nursing, Shahid Beheshti University of Medical Sciences, Isfahan, Iran
| | - Ali Akbar Jangjoo
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
OBJECTIVE To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. DATA SOURCES PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. STUDY SELECTION Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. DATA EXTRACTION Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. DATA SYNTHESIS The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. CONCLUSIONS This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.
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Al-Busaidi AA, Jeyaseelan L, Al-Barwani HM. The Accuracy of the Broselow™ Pediatric Emergency Tape for Weight Estimation in an Omani Paediatric Population. Sultan Qaboos Univ Med J 2017; 17:e191-e195. [PMID: 28690891 DOI: 10.18295/squmj.2016.17.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/07/2016] [Accepted: 02/05/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the accuracy of the Broselow™ Pediatric Emergency Tape (BT) for estimating weight in an Omani paediatric population at a tertiary care hospital. METHODS This retrospective cross-sectional study was conducted during July 2015. The electronic medical records of Omani outpatients <14 years old attending the Sultan Qaboos University Hospital, Muscat, Oman, between July 2009 and June 2013 were reviewed for recorded height and weight data. The BT Version 2002A was used to predict weight based on actual height measurements. Predicted weight measurements were then compared with actual weight to determine the accuracy of the estimation. RESULTS A total of 3,339 children were included in the study, of which 43.5% were female and 56.5% were male. The mean age was 6.4 ± 3.1 years and the mean height was 93.2 ± 23.5 cm. The mean actual weight was 13.9 ± 6.7 kg while the mean BT-predicted weight was 14.4 ± 6.9 kg. The BT-predicted weight estimations correlated significantly with actual weight measurements (intraclass correlation coefficient: 0.97; P <0.001). A Bland-Altman analysis indicated that the BT performed well when estimating weight among Omani children, with an overestimation of only 0.5 kg for the entire cohort. CONCLUSION The BT was found to be an effective tool for estimating weight according to body length in an Omani paediatric population. It should therefore be considered for use in emergency situations when actual weight cannot be determined.
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Affiliation(s)
| | - Lakshmanan Jeyaseelan
- Department of Statistics & Health Information, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hilal M Al-Barwani
- Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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33
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A smartphone application to determine body length for body weight estimation in children: a prospective clinical trial. J Clin Monit Comput 2017; 32:571-578. [PMID: 28660564 DOI: 10.1007/s10877-017-0041-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/22/2017] [Indexed: 12/13/2022]
Abstract
The aim of this study was to test the feasibility and accuracy of a smartphone application to measure the body length of children using the integrated camera and to evaluate the subsequent weight estimates. A prospective clinical trial of children aged 0-<13 years admitted to the emergency department of the University Children's Hospital Zurich. The primary outcome was to validate the length measurement by the smartphone application «Optisizer». The secondary outcome was to correlate the virtually calculated ordinal categories based on the length measured by the app to the categories based on the real length. The third and independent outcome was the comparison of the different weight estimations by physicians, nurses, parents and the app. For all 627 children, the Bland Altman analysis showed a bias of -0.1% (95% CI -0.3-0.2%) comparing real length and length measured by the app. Ordinal categories of real length were in excellent agreement with categories virtually calculated based upon app length (kappa = 0.83, 95% CI 0.79-0.86). Children's real weight was underestimated by physicians (-3.3, 95% CI -4.4 to -2.2%, p < 0.001), nurses (-2.6, 95% CI -3.8 to -1.5%, p < 0.001) and parents (-1.3, 95% CI -1.9 to -0.6%, p < 0.001) but overestimated by categories based upon app length (1.6, 95% CI 0.3-2.8%, p = 0.02) and categories based upon real length (2.3, 95% CI 1.1-3.5%, p < 0.001). Absolute weight differences were lowest, if estimated by the parents (5.4, 95% CI 4.9-5.9%, p < 0.001). This study showed the accuracy of length measurement of children by a smartphone application: body length determined by the smartphone application is in good agreement with the real patient length. Ordinal length categories derived from app-measured length are in excellent agreement with the ordinal length categories based upon the real patient length. The body weight estimations based upon length corresponded to known data and limitations. Precision of body weight estimations by paediatric physicians and nurses were comparable and not different to length based estimations. In this non-emergency setting, parental weight estimation was significantly better than all other means of estimation (paediatric physicians and nurses, length based estimations) in terms of precision and absolute difference.
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34
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Sutagatti JG, Raja R, Kurdi MS. Ultrasonographic Estimation of Endotracheal Tube Size in Paediatric Patients and its Comparison with Physical Indices Based Formulae: A Prospective Study. J Clin Diagn Res 2017; 11:UC05-UC08. [PMID: 28658880 DOI: 10.7860/jcdr/2017/25905.9838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/23/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Choosing the correct Endotracheal Tube (ETT) size is important in paediatric anaesthesia. The subglottic diameter being the narrowest diameter of the paediatric upper airway plays an important role in appropriate ETT size selection. AIM This study was planned to determine the accuracy of Ultrasonography (USG) to assess the appropriate ETT size and compare it with physical indices based formulae. The secondary outcome was to assess the number of times the tube was changed based on air leak test for USG estimated tube size. MATERIALS AND METHODS After ethical committee approval, a prospective clinical observational study for a period of one year was conducted on 75 children (power of study 80%, confidence interval 95%) aged one to 14 years of American Society of Anaesthesiologists Physical Status (ASA) I and II undergoing elective surgery under general anaesthesia with orotracheal intubation. Parental consent was obtained. Pre-anaesthetic ultrasonography was performed on every patient at the subglottic region. The tracheal subglottic diameter was estimated to select the ETT size for cuffed and uncuffed tubes. The size estimated by USG and that based on age and height based formulae were compared with clinically used appropriate tube size. Data analysis was done using IBM Statistical Package for the Social Sciences (SPSS) version 20.0; One-way Analysis of Variance (ANOVA) and t-test for comparison were used. RESULTS USG predicted the appropriate ETT size (p<0.05) better than physical indices based formulae for cuffed and uncuffed tubes. The age based formula predicted the clinically used ETT size well (p=0.58) and the height based formula did not correlate with clinically used tube size (p=0.0002 - a statistically significant value). Eight patients required change of tube once. CONCLUSION Ultrasonographic estimation of subglottic diameter is useful for optimal paediatric ETT size selection. USG is effective in estimating the appropriate sized ETT both for cuffed and uncuffed tubes.
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Affiliation(s)
- Jagadish G Sutagatti
- Associate Professor, Department of Radiodiagnosis, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Ranjana Raja
- Resident, Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Madhuri S Kurdi
- Professor, Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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Wirtz S, Eich C, Becke K, Brenner S, Callies A, Harding U, Höhne C, Hoffmann F, Kaufmann J, Landsleitner B, Marung H, Nicolai T, Reifferscheid F, Trappe U, Jung P. [Use of cognitive aids in pediatric emergency care : Interdisciplinary consensus statement]. Anaesthesist 2017; 66:340-346. [PMID: 28455650 DOI: 10.1007/s00101-017-0310-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preclinical pediatric emergencies are rare events and are therefore often associated with stress and uncertainty for emergency medical service personnel. To ensure adequate treatment of pediatric patients a variety of different cognitive aids exist (e.g. books, apps, rulers, weight-adapted bag systems). Especially the size specifications of the medical equipment and the dosage of emergency medication are individually very different in children and are dependent on parameters, such as body height and weight. Therefore, cognitive aids often enable length measurement whereby it is possible to draw conclusions on body weight for calculating the child's medication dosage. These aids may help to avoid the wrong medication dose or the wrong therapy of children but uncritical and untrained usage of these aids carries a potential risk of mistakes. This recommendation gives an overview of the general requirements and different problems of cognitive aids and should help improve the general framework and the rational basis for the use and further development of cognitive aids in emergency medicine.
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Affiliation(s)
- S Wirtz
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - C Eich
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland.,Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland.,Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - K Becke
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - S Brenner
- Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - A Callies
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - U Harding
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - C Höhne
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - F Hoffmann
- Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - J Kaufmann
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Landsleitner
- Wissenschaftlicher Arbeitskreis Kinderanästhesie (WAKKA), Deutschen Gesellschaft für Anästhesie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - H Marung
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - T Nicolai
- Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
| | - F Reifferscheid
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - U Trappe
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland
| | - P Jung
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e. V. (AGNN), Lübeck, Deutschland. .,Sektion Pädiatrische Intensiv- und Notfallmedizin der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland. .,Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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Precision Medicine With Point-of-Care Ultrasound: The Future of Personalized Pediatric Emergency Care. Pediatr Emerg Care 2017; 33:206-209. [PMID: 28248760 DOI: 10.1097/pec.0000000000001050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Precision Medicine Initiative spearheaded by the National Institute of Health has pioneered a new model of health care focused on health care delivery that is tailored to an individual. Medical advances have already provided clinicians with the tools to better predict treatment outcomes based on the individual needs of each patient's disease process. Three-dimensional printing allows medical devices and implants to be custom made-to-order. Technological advances in preoperative imaging have augmented the ability for surgeons to plan a specific surgical approach for each patient. In a similar vein, point-of-care ultrasound offers the emergency care provider an opportunity to move beyond protocols and provide precise medical care tailored to the acute needs of each ill or injured emergent patient. In this article, we explore several cutting-edge applications of point-of-care ultrasound that can help providers develop a personalized approach to resuscitation and emergent procedures in pediatrics.
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Chiengkriwate P, Donnapee R, Geater A. Brief communication (Original). The accuracy of the Broselow tape in the weight estimation of Thai children. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: The effectiveness of medical treatment depends on proper drug dosing. The most accurate measurement of a child’s weight is by weighing the child on a scale, and can be done for stable children. However, an emergency, or other conditions may preclude normal weighing. The child’s weight must then be estimated quickly for treatment including drug dosages, equipment sizes, ventilator volume settings, and cardioversiondefibrillation.
Objectives: To assess the accuracy of the Broselow tape in the weight estimation of Thai children.
Methods: Retrospective analysis reviewing the hospital-based data of 4746 Thai children aged less than 15 years. Demographic data, measured weight (MW), and height were collected. The subjects were divided into nine color-coded groups according to the Broselow tape color range and the actual weight plotted according to their groups. Comparison between Broselow tape-predicted weight (TW), height and MW was explored.
Results: A total of 3869 children met the inclusion criteria, of whom 2121 (54.8%) were male. The overall agreement between actual weight and predicted weight was 62.1% (range 36.4-90.5 depending on color-code). The mean difference between TW and MW was -3.56% (95% CI -3.964 to -3.150) with SD 12.91%, P < 0.001. TW was within a 10% error for 58% of children.
Conclusions: The accuracy of the Broselow tape in the weight estimation of Thai children decreases with increasing height. The Broselow tape underestimates Thai children’s weight.
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Affiliation(s)
- Piyawan Chiengkriwate
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Thailand
| | - Rattaporn Donnapee
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Thailand
| | - Alan Geater
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Thailand
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Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e31. [PMID: 28148473 PMCID: PMC5311423 DOI: 10.2196/jmir.7005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods. Conclusions In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- Department of Health and Community Medicine, Division of Clinical Epidemiology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Oliver Sanchez
- Department of Pediatric Surgery, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
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O'Leary F, John-Denny B, McGarvey K, Hann A, Pegiazoglou I, Peat J. Estimating the weight of ethnically diverse children attending an Australian emergency department: a prospective, blinded, comparison of age-based and length-based tools including Mercy, PAWPER and Broselow. Arch Dis Child 2017; 102:46-52. [PMID: 27799153 PMCID: PMC5256403 DOI: 10.1136/archdischild-2016-310917] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/01/2016] [Accepted: 09/03/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To prospectively compare the actual weights of Australian children in an ethnically diverse metropolitan setting with the predicted weights using the Paediatric Advanced Weight Prediction in the Emergency Room (PAWPER) tape, Broselow tape, Mercy system and calculated weights using the updated Advanced Paediatric Life Support (APLS), Luscombe and Owens and Best Guess formulae. METHODS A prospective, cross-sectional, observational, blinded, convenience study conducted at the Children's Hospital at Westmead Paediatric Emergency Department in Sydney, Australia. Comparisons were made using Bland-Altman plots, mean difference, limits of agreement and estimated weight within 10% and 20% of actual weight. RESULTS 199 patients were enrolled in the study with a mean actual weight of 27.2 kg (SD 17.2). Length-based tools, with or without body habitus adjustment, performed better than age-based formulae. When measuring estimated weight within 10% of actual weight, PAWPER performed best with 73%, followed by Mercy (69%), PAWPER with no adjustment (62%), Broselow (60%), Best Guess (47%), Luscombe and Owens (41%) and revised APLS (40%). Mean difference was similar across all methods ranging from 0.4 kg (0.0, 0.9) for Mercy to -2.2 kg (-3.5, -0.9) for revised APLS. Limits of agreement were narrower for the length-based tools (-5.9, 6.8 Mercy; -8.3, 5.6 Broselow; -9.0, 7.1 PAWPER adjusted; -12.1, 9.2 PAWPER unadjusted) than the age-based formulae (-18.6, 17.4 Best Guess; -19.4, 15.1 revised APLS, -21.8, 17.7 Luscombe and Owens). CONCLUSION In an ethnically diverse population, length-based methods with or without body habitus modification are superior to age-based methods for predicting actual body weight. Body habitus modifications increase the accuracy and precision slightly.
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Affiliation(s)
- Fenton O'Leary
- Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia,Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Blessy John-Denny
- Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia,Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn McGarvey
- Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Hann
- Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ioannis Pegiazoglou
- Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia,Disciplines of Emergency Medicine and Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Peat
- Australian Catholic University, Sydney, New South Wales, Australia
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Bowen L, Zyambo M, Snell D, Kinnear J, Bould MD. Evaluation of the accuracy of common weight estimation formulae in a Zambian paediatric surgical population. Anaesthesia 2016; 72:470-478. [PMID: 28026862 DOI: 10.1111/anae.13780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Abstract
Limited resources and access to healthcare in sub-Saharan Africa are associated with high rates of malnourished children, although many countries globally are demonstrating increasing childhood obesity. This study evaluated how well current age- or height-based formulae estimate the weight of children undergoing surgery in Zambia. All children under 14 years of age presenting for elective surgery at the University Teaching Hospital, Lusaka, had both height and weight measured. Their actual weight was compared against estimated weight from various formulae. The Broselow tape outperformed all the age-based formulae, demonstrating the lowest median percentage error of -5.8%, with 46.0% of estimates falling within 10% of the actual measured weight (p < 0.001). Of the 1111 children who were eligible for World Health Organization growth standard appraisal, 88 (8%) met the weight criteria for severe acute malnutrition. Our results are consistent with other studies in finding that the Broselow tape is the best estimator of weight in a lower middle-income country, followed by the original Advanced Paediatric Life Support formula if the Broselow tape is unavailable.
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Affiliation(s)
- L Bowen
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - M Zyambo
- Department of Anaesthesia, University Teaching Hospital, Lusaka, Zambia
| | - D Snell
- Department of Anaesthesia and Critical Care Medicine, Northumbria Healthcare NHS Foundation Trust, Wansbeck, UK
| | - J Kinnear
- Department of Anaesthesia and Critical Care Medicine, Southend University Hospital, Southend, UK.,Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
| | - M D Bould
- Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Cattermole GN, Graham CA, Rainer TH. Mid-arm circumference can be used to estimate weight of adult and adolescent patients. Emerg Med J 2016; 34:231-236. [PMID: 27993936 PMCID: PMC5502250 DOI: 10.1136/emermed-2015-205623] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 10/29/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022]
Abstract
Objectives Many drug and fluid regimens in emergency medicine are weight dependent in adults, but no standard adult weight estimation tools exist. Paediatric weight is often estimated in emergency situations using methods based on age or height when direct measurement is not possible, and recently, methods based on mid-arm circumference (MAC) have also been developed. The aim of this study was to derive and validate an accurate MAC-based method for weight estimation for use in all age groups. Methods Data were obtained from the US National Health and Nutrition Examination Survey (NHANES). MAC-based methods of weight estimation were derived in 8498 subjects (5595 adults aged 16–80 years, 2903 children aged 1–15.9 years) from the NHANES 2011–2012 dataset, using linear regression. NHANES 2009–2010 was used for validation in 9022 subjects (6049 adults aged 16–79 years, 2973 children aged 1–15.9 years). Results A simplified method of MAC-based weight estimation was derived from linear regression equation: weight in kg=4×MAC (in cm)—50. On validation, results in children aged 1–10.9 years were poor. In adults and children aged 11–15.9 years, over 60%, 90% and 98% of estimates fell, respectively, within 10%, 20% and 30% of actual weights when using the simplified formula. Conclusions In this description of a method for estimating weight in adults, we have derived and validated a simplified formula that is at least as precise in adults and adolescents as commonly used paediatric weight estimation tools in children.
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Affiliation(s)
- Giles N Cattermole
- Emergency Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
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Kim HY, Cheon JH, Baek SH, Kim KH, Kim TK. Prediction of endotracheal tube size for pediatric patients from the epiphysis diameter of radius. Korean J Anesthesiol 2016; 70:52-57. [PMID: 28184267 PMCID: PMC5296388 DOI: 10.4097/kjae.2017.70.1.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/12/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Using a too big or a too small size of an endotracheal tube in pediatric patients would result in tracheal injury or insufficient ventilation. Determining the appropriate endotracheal tube size is important because using an inappropriate size can cause complications. This study was performed to predict the appropriate endotracheal tube size by measuring the transverse diameter of the epiphysis of the distal radius under the assumption that the growth rates of cartilages in the entire body are close to each other. Methods Fifty-eight children aged 3 to 10 years who required general anesthesia were intubated with an uncuffed endotracheal tube. The tube size was considered to be appropriate when leaks occurred at inspiratory peak pressures between 10 to 25 mmHg. The transverse diameters of the epiphysis were measured with an ultra-sonogram at the distal radius and the proximal phalanx of the third finger and the fifth finger. Correlations and prediction probabilities of measurements were evaluated. The number needed to harm (NNH), which indicates the number of patients who need to be intubated for one patient who needs tube exchange, was investigated. Results The Spearman's correlation coefficient between the endotracheal tube size and the epiphysis of the distal radius was 0.814, which was the biggest coefficient. For epiphysis of the proximal phalanx of the third finger and the fifth finger, the correlation coefficient was 0.704 and 0.701, respectively. If the Cole's formula was applied for selection of the tube size, the NNH would be 7. Conclusions The appropriate endotracheal tube size could be predicted by means of the epiphyseal transverse diameter of the distal radius rather than the circumference measurements of the phalanx.
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Affiliation(s)
- Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital and School of Medicine, Yangsan, Korea
| | - Ji Hyun Cheon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital and School of Medicine, Yangsan, Korea
| | - Seung Hoon Baek
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital and School of Medicine, Yangsan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital and School of Medicine, Yangsan, Korea
| | - Tae Kyun Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital and School of Medicine, Yangsan, Korea
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Young KD, Korotzer NC. Weight Estimation Methods in Children: A Systematic Review. Ann Emerg Med 2016; 68:441-451.e10. [DOI: 10.1016/j.annemergmed.2016.02.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/09/2016] [Accepted: 02/19/2016] [Indexed: 01/08/2023]
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Ralston ME, Myatt MA. Weight Estimation Tool for Children Aged 6 to 59 Months in Limited-Resource Settings. PLoS One 2016; 11:e0159260. [PMID: 27529816 PMCID: PMC4987045 DOI: 10.1371/journal.pone.0159260] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 05/23/2016] [Indexed: 11/18/2022] Open
Abstract
Importance A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers. Objective To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries. Design This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992–2006 using a modified Expanded Program of Immunization two-stage cluster sample design. Setting Locations with high prevalence of acute and chronic malnutrition. Participants A total of 453,990 children met inclusion criteria (age 6–59 months; weight ≤ 25 kg; MUAC 80–200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values). Exposures Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined. Main Outcomes and Measures Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision. Results Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.15 kg; 2.24 kg). The height model fitted for MUAC classes was accurate and precise. For MUAC < 115 mm, the proportion of estimates accurate to within ± 25% of true weight was 97.15% (95% CI 96.90%, 97.42%) and the Bland-Altman bias and 95% limits of agreement were 0.08 kg and (-1.21 kg; 1.37 kg). For MUAC between 115 and 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.93% (95% CI 98.82%, 99.03%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-1.15 kg; 1.24 kg). For MUAC > 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.33% (95% CI 98.29%, 98.37%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.08 kg; 2.19 kg). Conclusions and Relevance Models estimating weight from height alone and height with MUAC class in children aged 6–59 months in a database from low-to-middle income countries were more accurate and precise than previous weight estimation tools. A height-based weight estimation tape stratified according to MUAC classes is proposed for children aged 6–59 months in limited-resource settings.
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Affiliation(s)
- Mark E. Ralston
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- * E-mail:
| | - Mark A. Myatt
- Brixton Health, Llawryglyn, Powys, Wales, United Kingdom
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Kim DK, Jhang WK, Ahn JY, Lee JS, Kim YH, Lee B, Kim GB, Kim JT, Huh J, Park JD, Chung SP, Hwang SO. Part 6. Pediatric advanced life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin Exp Emerg Med 2016; 3:S48-S61. [PMID: 27752646 PMCID: PMC5052919 DOI: 10.15441/ceem.16.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 01/11/2023] Open
Affiliation(s)
- Do Kyun Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Ji Yun Ahn
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ji Sook Lee
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei Universtiy College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Rappaport LD, Brou L, Givens T, Mandt M, Balakas A, Roswell K, Kotas J, Adelgais KM. Comparison of Errors Using Two Length-Based Tape Systems for Prehospital Care in Children. PREHOSP EMERG CARE 2016; 20:508-17. [PMID: 26836351 PMCID: PMC6292711 DOI: 10.3109/10903127.2015.1128027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The use of a length/weight-based tape (LBT) for equipment size and drug dosing for pediatric patients is recommended in a joint statement by multiple national organizations. A new system, known as Handtevy™, allows for rapid determination of critical drug doses without performing calculations. OBJECTIVE To compare two LBT systems for dosing errors and time to medication administration in simulated prehospital scenarios. METHODS This was a prospective randomized trial comparing the Broselow Pediatric Emergency Tape™ (Broselow) and Handtevy LBT™ (Handtevy). Paramedics performed 2 pediatric simulations: cardiac arrest with epinephrine administration and hypoglycemia mandating dextrose. Each scenario was repeated utilizing both systems with a 1-year-old and 5-year-old size manikin. Facilitators recorded identified errors and time points of critical actions including time to medication. RESULTS We enrolled 80 paramedics, performing 320 simulations. For Dextrose, there were significantly more errors with Broselow (63.8%) compared to Handtevy (13.8%) and time to administration was longer with the Broselow system (220 seconds vs. 173 seconds). For epinephrine, the LBTs were similar in overall error rate (Broselow 21.3% vs. Handtevy 16.3%) and time to administration (89 vs. 91 seconds). Cognitive errors were more frequent when using the Broselow compared to Handtevy, particularly with dextrose administration. The frequency of procedural errors was similar between the two LBT systems. CONCLUSION In simulated prehospital scenarios, use of the Handtevy LBT system resulted in fewer errors for dextrose administration compared to the Broselow LBT, with similar time to administration and accuracy of epinephrine administration.
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Mishra DG, Kole T, Nagpal R, Smith JP. A correlation analysis of Broselow™ Pediatric Emergency Tape-determined pediatric weight with actual pediatric weight in India. World J Emerg Med 2016; 7:40-3. [PMID: 27006737 DOI: 10.5847/wjem.j.1920-8642.2016.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Broselow™ Pediatric Emergency Tape indicates standardized, pre-calculated medication doses, dose delivery volumes, and equipment sizes using color-coded zones based on height-weight correlations. The present study attempted to provide more evidence on the effectiveness of the Broselow™ Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights. We hypothesized that the Broselow™ Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years, leading to inaccurate dosing and equipment sizing in the emergency setting. METHODS This prospective study of pediatric patients aged <10 years who were divided into three groups based on actual body weight: <10 kg, 10-18 kg, and >18 kg. We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias. Concordant results were those with a mean percent difference within 3%. Standard deviation was measured to determine precision. Accuracy was determined as color-coded zone prediction and measured weight concordance, including the percentage overestimation by 1-2 zones. RESULTS The male-to-female ratio of the patients was 1.3:1. Total agreement between color-coding was 63.18% (κ=0.582). The Broselow™ color-coded zone agreement was 74.8% in the <10 kg group, 61.24% in the 10-18 kg group, and 53.42% in the >18 kg group. CONCLUSIONS The Broselow™ Pediatric Emergency Tape showed good evidence for being more reliable in children of the <10 kg and 10-18 kg groups. However, as pediatric weight increased, predictive reliability decreased. This raises concerns over the use of the Broselow™ Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing >18 kg.
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Affiliation(s)
| | - Tamorish Kole
- Department of Emergency Medicine, Max Health Care, New Delhi 110017, India
| | - Rahul Nagpal
- Department of Pediatrics, Max Health Care, New Delhi 110017, India
| | - Jeffery Paul Smith
- Director of International Program, Ronald Reagan Institute of Emergency Medicine, GWU, USA
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Klučka J, Štourač P, Štoudek R, Ťoukálková M, Harazim H, Kosinová M. Controversies in Pediatric Perioperative Airways. BIOMED RESEARCH INTERNATIONAL 2015; 2015:368761. [PMID: 26759809 PMCID: PMC4670638 DOI: 10.1155/2015/368761] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/09/2015] [Accepted: 10/11/2015] [Indexed: 12/17/2022]
Abstract
Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient.
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Affiliation(s)
- Jozef Klučka
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Petr Štourač
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Roman Štoudek
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Michaela Ťoukálková
- Department of Pediatric Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Cernopolni 9, 613 00 Brno, Czech Republic
| | - Hana Harazim
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic
| | - Martina Kosinová
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty of Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic
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