Pediatr Emerg Med J.  2021 Dec;8(2):43-50. 10.22470/pemj.2021.00255.

Validation of the Broselow tape in Korean children using data from a nationwide anthropometric survey: a cross-sectional study

• Suh D
• Park J
• Kwak YH
• Kim DK
• Jung JY
• Lee JH
• Jang HY
• Kim HB
• Hong KJ

• KMID: 2523994
• DOI: http://doi.org/10.22470/pemj.2021.00255

Abstract

Purpose
In Korea, the Broselow tape (BT) is widely used to estimate weight in resuscitation. Validation of BT in Korean children is essential because the tool was developed based on children’s weight and height in the United States. The validation was previously performed in a small-scale dataset. The authors aimed to validate BT using the 2005 Korean nationwide anthropometric survey data.
Methods
From the population used for the survey, we sampled children aged 0-12 years. The weights estimated by BT were compared with measured weights of the children using Bland-Altman analysis with results recorded as percentage differences. We measured the accuracy of BT, defined as within a 10% error of the measured weight, and the concordance of the color-coded zones derived from the estimated and measured weights. The accuracy and concordance were further assessed according to the age groups and body mass index-for-age Z-score (< -2, underweight; > 2, overweight or obese).
Results
A total of 108,128 children were enrolled. The mean age was 55.2 ± 37.5 months. The bias was –5.4% (P < 0.001), and the limits of agreement were –28.3% and 17.6%, respectively. The accuracy and concordance of BT were 64.4% and 67.2%, respectively. Differences of no more than 1 color-coded zone between estimated and measured weights accounted for 89.8% and 84.1% of the under- and overweight (or obese) children, respectively.
Conclusion
BT accurately estimates weight in approximately two-thirds of Korean children. In addition, adjustment of 1 color-coded zone may be considered in children with extreme weight.

Keyword

Child; Heart Arrest; Overweight; Resuscitation; Weights and Measures

Figure

• 

  Fig. 1. Flowchart for the selection of study population. *A height outside the BT-applicable length (< 46.0 or > 146.7 cm). BT: Broselow tape.

• 

  Fig. 2. Bland-Altman plot indicating the percentages of differences showing the agreement between the estimated and measured weights. LOA: limits of agreement.

• 

  Fig. 3. Age group characteristics of the concordance between the estimated and measured color-coded zones. BT: Broselow tape.

Reference

References

1. Garland JS, Kishaba RG, Nelson DB, Losek JD, Sobocinski KA. A rapid and accurate method of estimating body weight. Am J Emerg Med. 1986; 4:390–3.

2. Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med. 1988; 17:576–81.

3. Tinning K, Acworth J. Make your best guess: an updated method for paediatric weight estimation in emergencies. Emerg Med Australas. 2007; 19:528–34.

4. Hughes G, Spoudeas H, Kovar IZ, Millington HT. Tape measure to aid prescription in paediatric resuscitation. Arch Emerg Med. 1990; 7:21–7.

5. Krieser D, Nguyen K, Kerr D, Jolley D, Clooney M, Kelly AM. Parental weight estimation of their child’s weight is more accurate than other weight estimation methods for determining children’s weight in an emergency department? Emerg Med J. 2007; 24:756–9.

6. Wells M, Goldstein LN, Bentley A, Basnett S, Monteith I. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - a systematic review and meta-analysis. Resuscitation. 2017; 121:9–33.

7. Nieman CT, Manacci CF, Super DM, Mancuso C, Fallon WF Jr. Use of the Broselow tape may result in the underresuscitation of children. Acad Emerg Med. 2006; 13:1011–9.

8. Ramarajan N, Krishnamoorthi R, Strehlow M, Quinn J, Mahadevan SV. Internationalizing the Broselow tape: how reliable is weight estimation in Indian children. Acad Emerg Med. 2008; 15:431–6.

9. Varghese A, Vasudevan VK, Lewin S, Indumathi CK, Dinakar C, Rao SD. Do the length-based (Broselow) tape, APLS, Argall and Nelson’s formulae accurately estimate weight of Indian children? Indian Pediatr. 2006; 43:889–94.

10. House DR, Ngetich E, Vreeman RC, Rusyniak DE. Estimating the weight of children in Kenya: do the Broselow tape and age-based formulas measure up? Ann Emerg Med. 2013; 61:1–8.

11. Khouli M, Ortiz MI, Romo-Hernández G, Martínez-Licona D, Stelzner SM. Use of the Broselow tape in a Mexican emergency department. J Emerg Med. 2015; 48:660–6.

12. Geduld H, Hodkinson PW, Wallis LA. Validation of weight estimation by age and length based methods in the Western Cape, South Africa population. Emerg Med J. 2011; 28:856–60.

13. Jang HY, Shin SD, Kwak YH. Can the Broselow tape be used to estimate weight and endotracheal tube size in Korean children? Acad Emerg Med. 2007; 14:489–91.

14. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008; 51:1–25. Korean.

15. World Health Organization (WHO). Body mass index-for-age [Internet]. Geneva: WHO;2021. [cited 2021 Apr 5]. Available from https://www.who.int/toolkits/child-growth-standards/standards/body-mass-index-for-age-bmi-for-age.

16. U.S. Centers for Disease Control and Prevention (CDC). Growth charts - percentile data files with LMS values [Internet]. Atlanta: CDC;2009. Aug. 4. [cited on 2021 Apr 5]. Avaialble from https://www.cdc.gov/growthcharts/percentile_data_files.htm.

17. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1:307–10.

18. Wells M, Coovadia A, Kramer E, Goldstein L. The PAWPER tape: a new concept tape-based device that increases the accuracy of weight estimation in children through the inclusion of a modifier based on body habitus. Resuscitation. 2013; 84:227–32.

19. Abdel-Rahman SM, Paul IM, James LP, Lewandowski A; Best Pharmaceuticals for Children Act-Pediatric Trials Network. Evaluation of the Mercy TAPE: performance against the standard for pediatric weight estimation. Ann Emerg Med. 2013; 62:332–9.

20. Wells M, Goldstein L, Bentley A. Accuracy of weight estimation by the Broselow tape is substantially improved by including a visual assessment of body habitus. Pediatr Res. 2018; 83:83–92.