The model proposed by the manufacturers of the BT was also included.įollowing four primary statistical measures were used to assess performance: The models were constrained to be simple enough to be used manually or with a simple mobile phone app. The models to be tested ( Table 1) were developed a priori, based on the findings of previous studies ( 22, 23, 24, 25). Z-scores of BMI-for-age were calculated for each child (using the World Health Organization BMI-for-age growth data for children under the age of 2 years and growth data from the Centers for Disease Control (2000) charts for children over the age of 2 years). The data that were used from each of the 1,085 children in this analysis included the following: age, sex, supine length, BT weight, BT color zone, habitus score (HS), and actual measured weight. Records from each of the contributing studies were pooled for the post hoc analysis complete data were available for every child. The child’s actual weight was then measured on a scale and recorded to the nearest 0.1 kg (Tanita SC-240 Body Composition Monitor-Class III device accurate to ☐.1 kg).ĭata extraction for the post hoc analysis The BT (2007 edition A for Study edition A for Studies 2 and 3) was used to generate an estimate of weight, according to the instructions on the tape.Ī visual inspection of the child was performed to assign a numerical quantification of body habitus according to previously described methods ( Figure 2) ( 18). Methods and Measurements Study procedureĪ standardized procedure was followed in each study:Įach child’s supine length was measured with a standard measuring tape. The exclusion criteria were children with congenitally abnormal stature (e.g., dwarfism) and children whose length could not be assessed (e.g., because of contractures). The inclusion criteria were children aged 1 month to 12 years (Studies 1 and 3) or 1 month to 16 years (Study 2). These data were obtained from convenience samples of children not requiring emergency medical care. The aims of these studies were to evaluate the weight estimation accuracy of the PAWPER tape, the Mercy method, and the original BT methodology. Study 2 enrolled 332 children from July 2014 to December 2014 in one center and Study 3 enrolled 300 children from August 2014 to January 2015 in a single center. Study 1 enrolled 453 children from September 2008 to October 2008 in two centers. Two of the hospitals serve a community of mostly low socioeconomic status and two serve a middle-class community. Study Design and SettingĮach study was a prospective, observational, cross-sectional study from four hospitals in Johannesburg, South Africa. Written informed consent was obtained from parents and written assent was obtained from children over the age of 7 years.
Permission to conduct the original studies as well as the secondary data analysis was obtained from the Human Research Ethics Committee of the University of the Witwatersrand. This was an analysis of pooled data from three previous studies evaluating various weight estimation systems, including the BT ( 11, 18, 21). The accuracy of the BT as a drug-dosing and weight-estimation device can be substantially improved by including an appraisal of body habitus in the methodology. The best weight-estimation model improved accuracy from 59.4 to 81.9% and reduced critical errors from 11.8 to 1.9%. The best dosing model improved dosing accuracy (doses within 10% of correct dose) from 52.0 to 69.6% and reduced critical dosing errors from 16.5 to 4.3%. Five dosing and four weight-estimation models were identified that markedly improved dosing and weight estimation accuracy, respectively. The habitus-modified method suggested by the manufacturer did not improve the accuracy of the BT. Sixteen a priori models generated a modified weight estimation or drug dose based on the BT weight and a gestalt assessment of habitus. MethodsĪ post hoc analysis of prospectively collected data from four hospitals in Johannesburg, South Africa, on a population of 1,085 children. This study evaluated the ability of habitus-modified models to improve the accuracy thereof. The manufacturers have suggested that a visual assessment of habitus may be used to increase its performance. The Broselow tape (BT) has been shown to estimate weight poorly primarily because of variations in body habitus.
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