The utility of pediatric age‐based weight estimation formulas for emergency drug dose calculations in obese children

• Published in: Journal of the American College of Emergency Physicians Open Vol. 1; no. 5; pp. 947 - 954
• Main Authors: Wells, Mike, Goldstein, Lara
• Format: Journal Article
• Language: English
• Published: United States John Wiley and Sons Inc 01.10.2020; Wiley
• Subjects: age formulas; drug dosing; ideal body weight; Original Research; PAWPER tape; pediatric obesity; Pediatrics; resuscitation; weight estimation; drug dosing; ideal body weight; resuscitation; PAWPER tape; pediatric obesity; age formulas; weight estimation
• ISSN: 2688-1152; 2688-1152
• DOI: 10.1002/emp2.12099

Objectives In obese children, when drug therapy is required during emergency care, an estimation of ideal body weight is required for certain drug dose calculations. Some experts have previously speculated that age‐based weight estimation formulas could be used to predict ideal body weight. The objectives of this study were to evaluate how accurately age‐based formulas could predict ideal body weight and total body weight in obese children. Methods Three age‐based weight estimation formulas were evaluated in a secondary analysis, using a pooled sample of children from 3 academic emergency departments in South Africa. The estimates produced by the 3 formulas (and the PAWPER XL tape as a control) were compared against measured total body weight and ideal body weight. The percentages of estimates falling within 10% of the standard weight were used as the primary outcome measure (PW10). Results This study included 1026 children. For ideal body weight estimations in obese children, the old Advanced Life Support formula, the new Advanced Life Support formula, and the Best Guess formula achieved PW10s (with 95% confidence intervals [CIs]) of 29% (27.2%, 30.8%), 41.4% (38.9%, 43.9%), and 48.3% (45.3%, 51.3%), respectively. For total body weight estimations, the formulas achieved PW10s of 3.6% (3.4%, 3.8%), 5.2% (4.9%, 5.5%), and 19.0% (17.8%, 20.2%). The PAWPER XL tape achieved an accuracy of ideal body weight estimation of 100% (93.9%, 100%) and total body weight estimation of 49.7% (46.7%, 52.7%) in obese children. Conclusions The age‐based formulas were substantially less accurate at estimating total body weight and ideal body weight than existing length‐based methods such as the PAWPER XL tape, and should not be used for this purpose.