Weighing a Critically Ill Child: The ‘Weight’ of Evidence

Excerpt

Accurate weight measurement in critically ill children is crucial for correct dosing of medications, fluids, nutrition, defibrillator joules and selection of appropriate sized equipment. Having said that, the actual weight of a child is not always known and weighing a sick child in emergency settings can be difficult. In the absence of recent weight records, a subjective estimation of weight by healthcare staff can often be misleading. Inaccurate weight estimation can lead to erroneous medication doses resulting in subtherapeutic or supratherapeutic levels. It has been reported that 10 to 31% of medication errors are related to inaccurate weight estimation [1]. Hence a reliable, quick, precise and valid estimation technique is required. The currently available formulae to predict weight from age or other anthropometric variables lack accuracy when applied to different population across the world [2]. Age based formulas like the European Pediatric Life Support formula underestimates weight with increasing age [2]. On the other hand, length based assessment using Broselow’s tape, the most commonly used method to calculate medication doses in critically ill children, overestimates weight in Indian children [3]. Nonetheless its modified version, the Indian Pediatric Weight Estimation tool (IPWET) was demonstrated to have higher accuracy [4]. However, it must be remembered that children’s weight is not strictly related to their age or length especially in obese. Hence weight estimation tools should incorporate parameters which depict body habitus like mid upper arm circumference (MUAC). The Pediatric Advanced Weight Prediction in the Emergency Room (PAWPER) XL-MAC tape is one such tool that uses both length and MAC to estimate weight [5]. Although it has been well validated in resource limited settings [5], studies validating the same in Indian children are lacking. …