A smartphone application to determine body length for body weight estimation in children: a prospective clinical trial

The aim of this study was to test the feasibility and accuracy of a smartphone application to measure the body length of children using the integrated camera and to evaluate the subsequent weight estimates. A prospective clinical trial of children aged 0–<13 years admitted to the emergency department of the University Children’s Hospital Zurich. The primary outcome was to validate the length measurement by the smartphone application «Optisizer». The secondary outcome was to correlate the virtually calculated ordinal categories based on the length measured by the app to the categories based on the real length. The third and independent outcome was the comparison of the different weight estimations by physicians, nurses, parents and the app. For all 627 children, the Bland Altman analysis showed a bias of −0.1% (95% CI −0.3–0.2%) comparing real length and length measured by the app. Ordinal categories of real length were in excellent agreement with categories virtually calculated based upon app length (kappa = 0.83, 95% CI 0.79–0.86). Children’s real weight was underestimated by physicians (−3.3, 95% CI −4.4 to −2.2%, p < 0.001), nurses (−2.6, 95% CI −3.8 to −1.5%, p < 0.001) and parents (−1.3, 95% CI −1.9 to −0.6%, p < 0.001) but overestimated by categories based upon app length (1.6, 95% CI 0.3–2.8%, p = 0.02) and categories based upon real length (2.3, 95% CI 1.1–3.5%, p < 0.001). Absolute weight differences were lowest, if estimated by the parents (5.4, 95% CI 4.9–5.9%, p < 0.001). This study showed the accuracy of length measurement of children by a smartphone application: body length determined by the smartphone application is in good agreement with the real patient length. Ordinal length categories derived from app-measured length are in excellent agreement with the ordinal length categories based upon the real patient length. The body weight estimations based upon length corresponded to known data and limitations. Precision of body weight estimations by paediatric physicians and nurses were comparable and not different to length based estimations. In this non-emergency setting, parental weight estimation was significantly better than all other means of estimation (paediatric physicians and nurses, length based estimations) in terms of precision and absolute difference.