This study set out to assess the accuracy of paramedics’ use of the Broselow tape measure in the pre-hospital arena. The Broselow tape uses a colour coded system to estimate the weight of a child based on his/her length. This provides the clinician with information to facilitate appropriate drug dosing and proper sizing of equipment to enable effective treatment.
Based in Los Angeles (LA), participants in the study included paramedic-level emergency medical technicians trained in the use of the Broselow tape. Standard paramedic practice in LA includes documentation of a Broselow weight for all paediatric patients regardless of presenting complaint.
This prospective study took place over a 12 month period from February 2008 and included paediatric patients under 145 cm tall (the upper limit for use of Broselow tape) who were transported by paramedics to the paediatric emergency department (ED). Subjects were excluded if a preexisting condition prevented proper measurement.
The study compared the paramedics’ estimation of Broselow weight against actual weight and height measured in the ED by the triage nurse, and a repeated Broselow weight and colour recorded by an emergency physician in the ED.
Overall, 572 patients were eligible for enrolment in the study. Of these, 538 (94 %) had a paramedic Broselow weight recorded, 491 (91 %) had an ED scale weight recorded, and 384 (71 %) had an ED Broselow weight recorded. All patients had either an ED scale or ED Broselow weight documented. As part of a sensitivity analysis, multiple imputation was carried out to account for missing data with 500 plausible data sets being created for each missing value.
Results indicated that the interrater agreement between the paramedic Broselow weight and ED Broselow weight was substantial with a weighted Cohen’s kappa coefficient of 0.74 (95 % CI 0.68–0.79).
Accuracy of paramedic Broselow weight when compared with ED scale weight as defined by the Pearson correlation coefficient was 0.92 (95 % CI 0.90–0.93); and paramedic Broselow weight when compared with the ED Broselow weight was 0.97 (95 % CI 0.97–0.98). It was noted that multiple imputation for missing data sets did not alter the results.
Limitations of the study were openly discussed in this paper, the main point being that the study was limited to one receiving hospital and one group of paramedics, thus restricting the generalisability of the results. Another area of concern included the potential for ED providers to see the paramedics’ Broselow tape measurements on the patients’ records before conducting their own assessment, which could have influenced the ED recordings.
Clearly accurate weight estimation of paediatric patients is of great importance when determining appropriate drug dosages and selecting appropriately sized equipment.
The study concludes that paramedic Broselow weight measurement is a good approximation and is as accurate as ED Broselow weight measurements. The authors suggest that ambulance services can reliably incorporate its use into pre-hospital paediatric protocols and that ED physicians can be confident of the Broselow weight estimations determined by pre-hospital personnel.
However, the authors do raise a note of caution, particularly pertinent given current upward trends of child obesity.
It appears that other studies have shown a tendency to underestimate the weight of obese children when using the tape, and so this area shall require further investigation before relying on results from the Broselow tape within this group of patients.