Literature Review: Paramedic Broselow Weights
Heyming T, Bosson N, Kurobe A, et al. Accuracy of paramedic Broselow tape use in the prehospital setting. Prehosp Emerg Care 2012 Jul–Sep; 16(3): 374–80.
The Broselow tape is widely used to rapidly estimate weight and facilitate proper medication dosing in pediatric patients. [Authors] aimed to determine the accuracy of prehospital use of the Broselow tape. Methods—[Authors] prospectively enrolled a consecutive sample of pediatric patients transported to the emergency department (ED) at Harbor-UCLA Medical Center from February 2008 to January 2009. Eligible subjects arrived via ambulance and were less than 145 cm tall, the upper limit of height for Broselow measurements. Subjects were excluded if they had a medical condition preventing proper measurement (e.g., contractures). Per Los Angeles County protocol, paramedics obtained a Broselow weight on all pediatric patients. The paramedic Broselow weight was compared with the ED Broselow weight and the ED scale weight, which was obtained unless mobilization was contraindicated. Accuracy was determined by assessing Bland-Altman plots and the Pearson correlation coefficient. As part of a sensitivity analysis, multiple imputation was used to account for missing data.
Results—There were 572 subjects enrolled. The median age was 24 months; 55% of the subjects were male. The weighted Cohen’s kappa assessing agreement between the paramedic and ED Broselow colors was 0.74. The median difference between the paramedic Broselow weight and the scale weight was -0.10 kg. The accuracy of the paramedic Broselow weight when compared with the ED scale weight and the ED Broselow weight as defined by Pearson’s correlation coefficient was 0.92 and 0.97, respectively. Conclusion—Paramedic Broselow weight correlates well with scale weight and ED Broselow weight. Paramedics can use the Broselow tape to accurately determine weight for pediatric patients in the prehospital setting.
In the December 2011 issue I reviewed a study that showed dosing errors in pediatric patients were common: 35% of administered medication dosages were more than 20% too high or too low. Part of the problem is that pediatric resuscitation a high-risk/low-frequency event, and, with the emotional component of treating a sick/injured kid, is a stressful and challenging encounter. The solution must be simple and universal: an approach that ideally is used consistently in every case. The authors argue that the Broselow tape can be part of such an approach.
The noise around this subject has only created confusion and indecision. Does the Broselow tape work for all ethnic groups? For boys and girls? How about the (now more common) obese patients? How good is the mom’s estimate of the weight? The fact is that other weight-estimation methods (age-based calculations, parent estimation, provider estimation), although possibly somewhat useful in the office or clinic setting, are either less accurate or less practical for EMS. What if you don’t know a child’s age? If a parent is not there? If a parent is altered and can’t tell you (or gives you an incorrect) age/weight?
The Broselow tape has been around for more than 25 years and validated in multiple clinical trials. It is simple, light, durable and universal. These authors have shown it is highly accurate for EMS patients, regardless of size or severity of illness/injury. They also point out that most resuscitation medications given in EMS are best dosed on lean body mass (ideal weight, not actual weight), so for obese patients the height may be an even better predictor of most effective dose than weight.
If one (and only one) method were used to determine the size of devices and dose of medications for all pediatric patients every time, the error rate would be expected to decrease. EMS systems should consider standardizing on one weight-estimation method, and the Broselow tape may be the most appropriate tool.
Angelo Salvucci, Jr., MD, FACEP, is medical director for the Santa Barbara County and Ventura County (CA) EMS agencies and a member of the EMS World editorial advisory board.