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Which paediatric weight formula is best suited for the out-of-hospital field?

08 October 2012
Features
02 October 2012
Volume 4 · Issue 10

Abstract

Background: Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drug dosages, fluid therapy and defibrillation. In the pre-hospital field the treatment of a patient needs to occur in a timely and accurate fashion, this necessity drives the need for an accurate weight estimation formula. The objective of this study was to identify a paediatric weight estimation formula relevant to the pre-hospital field.

Methods: A literature review was undertaken using a variety of electronic medical databases from their commencement date until the end of May 2012. Keywords used in the search included: Weight estimation, drug calculations, pediatric, paediatric, EMS, EMT, paramedic, emergency medical service, emergency medical technician, pre-hospital, out-of-hospital and ambulance. The keywords were used individually and in combination. The inclusion criterion was any study type that described the development or evaluation of a paediatric weight calculation in the pre-hospital or hospital setting.

Findings: There were 635 articles located with 25 meeting the inclusion criteria. The commonly used APLS weight estimation formula significantly underestimates a child’s weight. The best guess formula appears to be more accurate at estimating the weight; however more research needs to be conducted to validate this method for the pre-hospital field.

Conclusion: As the average weight of children increases, the accuracy of weight estimation formulas decreases, suggesting that these methods will be unable to sufficiently adjust to deal with future rises in average weights of children. Further research is required to determine the most appropriate formula for paramedics to use in the pre-hospital setting.

Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drugs dosages, endotracheal tube size, fluid therapy and defbrillation. For a number of varying reasons, the ‘gold standard’ of actually weighing the patient in the pre-hospital field is not feasible. Previous work conducted by a number of researchers suggests that weight estimation by medical staff is of moderate accuracy, with other health care professionals estimates being grossly inaccurate (Greig et al, 1997; Uesugi et al, 2002; Hall et al, 2004; Menon and Kelly, 2005; Partridge et al, 2009). Research suggests paramedics are the least accurate of all health professionals (attending physicians, residents, interns, nurses, medical students and paramedics) (Hall et al, 2004). Parents’ estimates of their child’s weight are reasonably accurate (Wald et al, 2007; Partridge et al, 2009) however they are not always available in the unpredictable pre-hospital environment, and thus weight-based formulae are a crucial component in the pre-hospital management of a paediatric patient.

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Out-of-hospital
Pre-hospital
Paediatric
Weight formula