Broselow tape or APLS formula to estimate weight in children
- Report By: Katherine Potier - Specialist Registrar in Emergency Medicine
- Search checked by Reddy Mahu - Specialist Registrar in Emergency Medicine
- Institution: Wythenshawe Hospital
- Date Submitted: 6th February 2003
- Last Modified: 6th February 2006
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Status:
Blue (submitted but not checked)
Three Part Question
In [children undergoing resuscitation] is [the APLS age based formula more accurate than the Broselow tape] at [estimating a child's weight]?Clinical Scenario
You are put on standby for a 22 month child who has been hit by a car. As you are preparing for his arrival you wonder whether the APLS age based formula will be more accurate at estimating his weight than the Broselow tape, as direct weighing may not be possible.Search Strategy
Search Strategy Medline 1966-01/05 using the Ovid interface.[(exp body weight/ and estimat$.mp) OR (weight estimation.mp.)] AND [(broselow.mp.) OR (APLS or (advanced adj pediatric adj life adj support) or (advanced adj paediatric adj life adj support).mp.) OR (comparative study/ and (method$ or technique$).mp)] AND [Best bets paediatric filter] LIMIT to human and English.
Search Outcome
292 papers were found of which 4 addressed the three part question.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Argall et al, 2003, UK | ED. Convenience sample 300, aged 1-10 | Case study | Estimated weight using 2 methods, actual weight and height | Mean bias –3.52kg for APLS, -2.74kg for tape. Both underestimate weight, this increases with age. | Convience sample, not powered. No subjects less than 1yr. |
| Black et al, 2002, Australia | ED. 495 sample, 6 methods of weight estimation used (APLS, Broselow tape, devised weight estimation(DWEM), Oakley table, Traub-Johnson, Traub-Kichen) | Prospective observational | Weight via 6 methods compared with actual weight | <10kg mean bias –0.6 with tape. 10-20kg, -0.4 with tape, -4.7 with APLS 25-40kg, -6.4 with tape, -20 with APLS. 2 best methods DWEM and Broselow tape. | One person did all measurements. |
| Hofer et al, 2002, Switzerland | 585 elective surgery cases. Reviewed anaesthetic charts | Retrospective case series | Broselow tape vs age based formula to assess weight, and tracheal tube size | -0.52kg bias for Broselow tape. Tape estimated correct ET tube size in more children (55% vs 41% with age based formula) | Retrospective sample. Elective population. |
| Lubitz et al, 1988, USA | 1002 cases (from ED, PICU, outpatients) aged 2 wks-11 yrs. Actual weight vs weight estimated by Broselow tape. (original study using Broselow tape for first time) | Prospective case series | Accuracy of Broselow tape compared with actual weight and height/length | Tape underestimates weight by 0.5kg (p<0.0001). 79.2% of tape estimates within +/-15% true weight. Accuracy of tape decreases above 25kg. | Case series, not powered. |
Comment(s)
Commonly used methods to estimate childrens weight in the resuscitation situation tend to be based on age. However over recent years children are tending to be heavier and these methods may be losing some accuracy. At the same time they rely on knowing the childs age and memorising a formula. The studies looked at tend to show less bias with the Broselow tape compared with age based formulas. In addition the tape is easy to use by all health care staff.Clinical Bottom Line
The APLS formula is commonly used however it may be losing some accuracy in the face of a population of children who seem to becoming heavier. The Broselow tape appears to be a useful alternative that can be used by all healthcare personnel, and may indeed be more accurate.References
- Argall J, Wright N, Macway-Jones K, Jackson R. A comparison of two commonly used methods of weight estimation. Archives of diseases in Childhood 2003;88:789-790.
- Black K, Barnett P, Wolfe R, Young S. Are methods used to estimate weight in children accurate? Emergency Medicine 2002;14:160-165.
- Hofer C, Ganter M, Tucci m, Klaghofer R, Zollinger A. How reliable is length based determination of body weight and tracheal tube size in the paediatric age group?The Broselow tape reconsidered.' British Journal of Anaesthesia 2002;88:283-5.
- Lubitz D, Seidel J, Chameides L, Luten R, Zaritsky A, Campbell F. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Annals of Emergency Medicine 1988;17:576-81.