Weight estimation in an inner-city pediatric ED: the effect of obesity

Background and Objective: Weight estimation for pediatric resuscitation occurs frequently in emergency departments. Historically, different approaches to estimation have been studied with varied results. With increasing obesity rates among inner-city children, this study aims to determine the best method for pediatric weight estimation in our population. Methods: This is a prospective, nonblinded, observational study. A total of 324 patients (aged 1 month to 12 years) were enrolled in the study to exceed sample size calculations. The accuracy of 4 methods for weight estimation-the Broselow tape, advanced pediatric life support formulas, the PAWPER tape, and mid-arm circumference formula-were compared across age ranges and body sizes to determine the most appropriate method for our population. Results: In this inner-city population, 32% of the patients 2 to 12 years of age were found to be overweight or obese. This rate increased to 41% for patients 6 to 12 years of age. In this setting, the PAWPER tape outperformed the other 3 methods, estimating patients' weight within +/-5% of actual weight in 35.2% of our cohort. When compared with the other 3 methods tested, the PAWPER tape was statistically superior with a P value less than .02 in each case. Conclusion: Each of the methods tested in our population performed poorly. Current methods for weight estimation should be used with caution, especially for populations with an increased prevalence of obesity. Efforts should be dedicated to improving or deriving new methods for weight estimation that perform better in this vulnerable population. (C) 2015 Elsevier Inc. All rights reserved.