1Institute of Anaesthesiology, Triemli City Hospital, 2Department of Anaesthesiology, 3Biostatistics, Department of Psychosocial Medicine, University Hospital, Zürich 4Present address: Department of Anaesthesiology, University Hospital, Lausanne, Switzerland*Corresponding author: Institute of Anaesthesiology, Triemli City Hospital, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland
Accepted for publication: October 16, 2001
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Abstract |
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Methods. Age, body length and body weight measured before surgery as well as the size of the tracheal tube used were recorded. The body weight was estimated on the basis of body length using the Broselow tape and was compared with the measured weight. Tracheal tube size selections using the Broselow tape and an age-based formula were compared with the size of the tube used.
Results. A good correlation was found between the Broselow weight and the measured weight (r2=0.88). BlandAltman analysis revealed a mean bias of 0.52 kg for the entire study population. For children 20 kg the mean bias was 0.05 kg, and for children >20 kg was 1.05 kg. The Broselow weight was found to be within a 10% error of the measured weight in 65% of children. Tracheal tube selection by the Broselow tape method was adequate in 55% but underestimated the actual tube size in 39%. The age-based formula matched the actual tracheal tube size in 41% of children but overestimated it in 57%.
Conclusions. The Broselow tape is an accurate means to assess body weight from length in smaller children; in older children it underestimated body weight. Endotracheal tube size selection by the Broselow tape appears to match the size of the tube used better than the age-based formula. The results in a European sample of children are comparable to the US data.
Br J Anaesth 2002; 88: 2835
Keywords: anaesthesia, dosage; anaesthesia, paediatric; intubation, tracheal; measurement techniques, Broselow tape
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Introduction |
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Methods and results |
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Length-based weight determination
The body weight was estimated using the Broselow tape (Broselow weight) on the basis of the body length measured before surgery, and was compared with the measured body weight. Using a BlandAltman plot (Fig. 1) to determine the mean bias and the limits of agreement.6 7 There was a statistically significant mean bias of 0.52 kg (P<0.0001) and the limits of agreement were 5.8 kg and 4.8 kg (Fig. 1). The mean bias for children 20 kg was 0.05 kg (limits of agreement: 3.0/2.9 kg) and for children >20 kg was 1.05 kg (limits of agreement: 8.0/5.9 kg).
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Length-based tracheal tube size selection
The tracheal tube size selection using the Broselow tape was the same as the size used in 55% of cases, and underestimated the used size in 39% of cases. Results of the two different weight groups were comparable (matching 20 kg: 57%; >20 kg: 53%). Tracheal tube size selection using the age-based standard formula ([age in years+16]41) matched the used size in 41% of cases, and overestimated it in 57% of cases. There was a significant difference in tracheal tube size selection between the Broselow tape method and the age-based formula (P<0.001,
2-test).
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Comment |
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The tracheal tube size selection by the Broselow tape met clinical needs better than estimation using a standard age-based formula. Correct match was more frequent using the tape than the formula. Moreover, the observed underestimation by the tape may be less relevant clinically in terms of airway injury than the frequent overestimation that occurs when using the standard age-based formula.
The results of the current study performed in a European paediatric population are comparable to the published data in US paediatric populations for body weight estimation3 and tracheal tube size selection.4 However, tracheal tube size selection using the Broselow tape was not superior to the age-based formula used in one US study.5
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References |
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3 Lubitz DS, Seidel JS, Chameides L, et al. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med 1988; 17: 57681[ISI][Medline]
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6 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 30710[ISI][Medline]
7 Mantha S, Roizen MF, Fleisher LA, et al. Comparing methods of clinical measurement: reporting standards for Bland and Altman analysis. Anesth Analg 2000; 90: 593602